Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes.

Abstract

AIMS:

Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy.We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes.

METHODS AND RESULTS:

Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death.Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy.

CONCLUSION:

Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE.

• Authors: Maulik D Majmudar, Venkatesh L Murthy, Ravi V Shah, Swathy Kolli, Negareh Mousavi, Courtney R Foster, Jon Hainer, Ron Blankstein, Sharmila Dorbala, Arkadiusz Sitek, Lynne W Stevenson, Mandeep R Mehra, Marcelo F Di Carli
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 16 Issue 8 Pg. 900-9 (Aug 2015) ISSN: 2047-2412 [Electronic] England
• PMID: 25719181 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: [email protected].

Topics

• Aged
• Cardiomyopathies (diagnostic imaging, physiopathology)
• Electrocardiography
• Female
• Fractional Flow Reserve, Myocardial
• Humans
• Male
• Myocardial Ischemia (diagnostic imaging, physiopathology)
• Myocardial Perfusion Imaging (methods)
• Stroke Volume
• Ventricular Dysfunction, Left (diagnostic imaging, physiopathology)