European Heart Journal Advance Access published online on February 7, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi795
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1 Cardiology Division, Umberto I° Hospital, Mestre-Venice, Italy
* To whom correspondence should be addressed. 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 Conclusion In DCM patients, CFR is often impaired. A reduced CFR during vasodilator stress is an independent prognostic marker of bad prognosis.
Received September 22, 2005
Revised January 12, 2006
Accepted January 26, 2006
Clinical research
The prognostic impact of coronary flow-reserve assessed by Doppler echocardiography in non-ischaemic dilated cardiomyopathy
Fausto Rigo 1,
Sonia Gherardi 2,
Maurizio Galderisi 3,
Lorenza Pratali 4,
Lauro Cortigiani 5,
Rosa Sicari 4 *,
and
Eugenio Picano 4
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
Rosa Sicari, E-mail: rosas{at}ifc.cnr.it
Abstract 
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.
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