Media Release

​New findings for fatal blockages in heart’s small arteries, paves new way for heart failure treatment

Disease of the small heart arteries (also known as Microvascular Dysfunction) has been found to be very common and important in patients with heart failure with preserved ejection fraction (HFpEF1), the top cause of hospitalisations among elderly Singaporeans. An international team of researchers, including from National Heart Centre Singapore, report in a study published in The European Heart Journal. 
Heart failure is the top cause of hospital admissions among elderly Singaporeans, and occurs when the heart cannot function properly leading to fluid accumulation in the lungs. HFpEF, a dominant type of heart failure worldwide, represents at least one third of all Singaporean patients with heart failure. In spite of its detrimental effects and significant public health burden, it often goes undetected, due to the lack of proper understanding and therefore treatment for such heart failure patients is far from optimal.

A study led by a team of international researchers on over 200 patients with this type of heart failure found that 75 per cent of the patients had what is known as microvascular dysfunction. This is a disease in which the large (macrovascular) coronary artery shows no sign of narrowing, but the downstream smaller arteries are abnormal. This leads to adverse changes in the heart muscle which was shown in the study. There was also evidence of parallel changes in the small arteries of the kidney. The researchers therefore draw the conclusion that microvascular dysfunction can be a critical underlying disease mechanism in patients with heart failure in which the ejection fraction is preserved.

“PROMIS-HFpEF is the first and largest multinational prospective HFpEF study to show that microvascular dysfunction (disease of the small heart arteries rather than the large heart arteries involved in heart attacks) is very common, a promising composite risk marker and potential drug target in HFpEF. This is important because there is still no effective treatment for HFpEF. These landmark results support ongoing and new trials of drugs targeting microvascular dysfunction in HFpEF, which I am grateful to lead as part of the global steering committees,” said Professor Carolyn Lam, Senior Consultant, Department of Cardiology at the National Heart Centre Singapore and Professor, Duke-NUS Cardiovascular Academic Clinical Programme, the co-first author of this research study. This landmark finding was presented at the European Society of Cardiology latebreaking trial session held from 25 to 29 August in Munich, Germany, the world’s largest cardiovascular congress with participants of over 32,000 healthcare professionals.


1HFpEF refers to a form of congestive heart failure where the amount of blood pumped from the heart’s left ventricle with each beat (ejection fraction) is greater than 50%.