Key result
High resting coronary flow velocity was associated with significantly worse survival (HR 2.407) in patients with ischemic and nonischemic heart failure with reduced ejection fraction.
Why the study?
Patients with HF and reduced LVEF have a heterogeneous prognosis, and assessment of coronary physiology with CFV and CFVR may complement established predictors based on wall motion and EF.
Does the combined echocardiographic assessment of resting coronary flow velocity, coronary flow velocity reserve, and wall motion predict survival in patients with heart failure and abnormal ejection fraction?
Cohort (n=1,408)
Yes
Does the combined echocardiographic assessment of resting coronary flow velocity, coronary flow velocity reserve, and wall motion predict survival in patients with heart failure and abnormal ejection fraction?
Hazard Ratio: 2.407 (95% CI 1.871–3.096)
p-value: p=<0.001
High resting coronary flow velocity and reduced coronary flow velocity reserve provide independent and additive prognostic value to ejection fraction and wall motion in patients with heart failure and reduced ejection fraction.
Background and Aims Patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF) have a heterogeneous prognosis, and assessment of coronary physiology with coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) may complement established predictors based on wall motion and EF. Methods and results In a prospective multicenter study design, we enrolled 1,408 HF patients (age 66 ± 12 years, 1,035 men), with EF <50%, 743 (53%) with coronary artery disease, and 665 (47%) with normal coronary arteries. Recruitment (years 2004–2022) involved 8 accredited laboratories, with inter-observer variability <10% for CFV measurement. Baseline CFV (abnormal value >31 cm/s) was obtained by pulsed-wave Doppler in mid-distal LAD. CFVR (abnormal value ≤2.0) was assessed with exercise ( n = 99), dobutamine ( n = 100), and vasodilator stress (dipyridamole in 1,149, adenosine in 60). Inducible myocardial ischemia was identified with wall motion score index (WMSI) stress > rest (cut-off Δ ≥ 0.12). LV contractile reserve (CR) was identified with WMSI stress < rest (cutoff Δ ≥ 0.25). Test response ranged from score 0 (EF > 30%, CFV ≥ 32 cm/s, CFVR > 2.0, LVCR present, ischemia absent) to score 5 (all steps abnormal). All-cause death was the only endpoint. Results. During a median follow-up of 990 days, 253 patients died. Independent predictors of death were EF (HR: 0.956, 95% CI: 0.943–0.968, p < 0.0001), CFV (HR: 2.407, 95% CI: 1.871–3.096, p < 0.001), CFVR (HR: 3.908, 95% CI: 2.903–5.260, p < 0.001), stress-induced ischemia (HR: 2.223, 95% CI: 1.642–3.009, p < 0.001), and LVCR (HR: 0.524, 95% CI: 0.324–.647, p = 0.008). The annual mortality rate was lowest (1.2%) in patients with a score of 0 ( n = 61) and highest (31.9%) in patients with a score of 5 ( n = 15, p < 0.001). Conclusion High resting CFV is associated with worse survival in ischemic and nonischemic HF with reduced EF. The value is independent and additive to resting EF, CFVR, LVCR, and inducible ischemia.
No takes yet. Share an insight, caveat, or question.
Ciampi et al. (2023) conducted a cohort in Heart failure with reduced or mildly reduced ejection fraction (n=1,408). High resting coronary flow velocity (CFV) vs. Normal resting coronary flow velocity was evaluated on All-cause death (HR 2.407, 95% CI 1.871-3.096, p=<0.001). High resting coronary flow velocity was associated with significantly worse survival (HR 2.407) in patients with ischemic and nonischemic heart failure with reduced ejection fraction.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: