European Heart Journal Advance Access originally published online on February 7, 2006
European Heart Journal 2006 27(11):1319-1323; doi:10.1093/eurheartj/ehi795
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The prognostic impact of coronary flow-reserve assessed by Doppler echocardiography in non-ischaemic dilated cardiomyopathy
1 Cardiology Division, Umberto I° Hospital, Mestre-Venice, Italy
2 Cardiology Division, Cesena Hospital, Cesena, Italy
3 Cardioangiology Unit, Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
4 CNR, Institute of Clinical Physiology, Via. G. Moruzzi 1, 56124 Pisa, Italy
5 Cardiology Division, Campo di Marte Hospital, Lucca, Italy
Received 22 September 2005; revised 12 January 2006; accepted 26 January 2006; online publish-ahead-of-print 7 February 2006.
* Corresponding author. Tel/Fax: +39 (0) 50 315 2374. E-mail address: rosas{at}ifc.cnr.it
See page 1266 for the editorial comment on this article (doi:10.1093/eurheartj/ehl011)
Aims Coronary flow-reserve (CFR) can be impaired in non-ischaemic dilated cardiomyopathy (DCM), unmasking a coronary microcirculatory dysfunction of potential prognostic impact. The aim of the present study is to evaluate the prognostic value of Doppler echocardiographic-derived CFR in patients with DCM.
Methods and results We evaluated 129 DCM patients (85 male; age 62±11) by transthoracic dipyridamole (0.84 mg/kg in 10 min) stress echocardiography. All patients had an ejection fraction <40% (mean 32±7) and angiographically normal coronary arteries with NYHA class
3. CFR was assessed on left anterior descending artery using pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. All patients were followed-up for a median of 22 months. Mean CFR was 2.0±0.5. At individual patient analysis 46 patients had normal (CFR>2.0) and 83 had abnormal CFR. During follow-up, 18 patients died and 33 showed worsening of NYHA class. The worse event-free survival was observed in those patients with an abnormal CFR when compared with those having a normal CFR at high dose of dipyridamole (70 vs. 22%, at 75 months of follow-up, P<0.0001). In the multivariable analysis, severity of mitral insufficiency (HR=1.9, 95% CI=1.06–2.87), abnormal CFR (HR=4.0, 95% CI=1.1–15.6), resting wall motion score index (HR=6.9, 95% CI=1.5–30.7) were independent predictors of survival.
Conclusion In DCM patients, CFR is often impaired. A reduced CFR during vasodilator stress is an independent prognostic marker of bad prognosis.
Key Words: Coronary flow-reserve • Transthoracic echocardiography • Prognosis • Dipyridamole
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