Impaired coronary flow reserve in patients with supra-normal left ventricular ejection fraction at rest.

Abstract

PURPOSE:

Recently, a "U" hazard ratio curve between resting left ventricular ejection fraction (LVEF) and prognosis has been observed in patients referred for routine clinical echocardiograms. The present study sought to explore whether a similar "U" curve existed between resting LVEF and coronary flow reserve (CFR) in patients without severe cardiovascular disease (CVD) and whether impaired CFR played a role in the adverse outcome of patients with supra-normal LVEF (snLVEF, LVEF ≥ 65%).

METHODS:

Two hundred ten consecutive patients (mean age 52.3 ± 9.3 years, 104 women) without severe CVD underwent clinically indicated rest/dipyridamole stress electrocardiography (ECG)-gated 13 N-ammonia positron emission tomography/computed tomography (PET/CT). Major adverse cardiac events (MACE) were followed up for 27.3 ± 9.5 months, including heart failure, late revascularization, re-hospitalization, and re-coronary angiography for any cardiac reason. Clinical characteristics, corrected CFR (cCFR), and MACE were compared among the three groups categorized by resting LVEF detected by PET/CT. Dose-response analyses using restricted cubic spline (RCS) functions, multivariate logistic regression, and Kaplan-Meier survival analysis were conducted to evaluate the relationship between resting LVEF and CFR/outcome.

RESULTS:

An inverted "U" curve existed between resting LVEF and cCFR (p = 0.06). Both patients with snLVEF (n = 38) and with reduced LVEF (rLVEF, LVEF < 55%) (n = 66) displayed a higher incidence of reduced cCFR than those with normal LVEF (nLVEF, 55% ≤ LVEF < 65%) (n = 106) (57.9% vs 54.5% vs 34.3%, p < 0.01, respectively). Both snLVEF (p < 0.01) and rLVEF (p < 0.05) remained independent predictors for reduced cCFR after multivariable adjustment. Patients with snLVEF encountered more MACE than those with nLVEF (10.5% vs 0.9%, log-rank p = 0.01).

CONCLUSIONS:

Patients with snLVEF are prone to impaired cCFR, which may be related to the adverse prognosis. Further investigations are warranted to explore its underlying pathological mechanism and clinical significance.

• Authors: Ping Wu, Xiaoli Zhang, Zhifang Wu, Huanzhen Chen, Xiaoshan Guo, Chunrong Jin, Gang Qin, Ruonan Wang, Hongliang Wang, Qiting Sun, Li Li, Rui Yan, Xiang Li, Marcus Hacker, Sijin Li
• Journal: European journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 49 Issue 7 Pg. 2189-2198 (06 2022) ISSN: 1619-7089 [Electronic] Germany
• PMID: 34988625 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Topics

• Adult
• Cardiovascular Diseases
• Coronary Angiography
• Female
• Humans
• Middle Aged
• Positron Emission Tomography Computed Tomography
• Prognosis
• Stroke Volume
• Ventricular Function, Left