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<or=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.
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 DCMpatients (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<or=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 DCMpatients, CFR is often impaired. A reduced CFR during vasodilator stress is an independent prognostic marker of bad prognosis.
Authors: Attila Nemes; Tamás Forster; Marcel L Geleijnse; Osama I I Soliman; Folkert J Ten Cate; Miklós Csanády Journal: Heart Vessels Date: 2008-05-17 Impact factor: 2.037
Authors: Amanda J Ross; Zhaohui Gao; Jonathan Carter Luck; Cheryl A Blaha; Aimee E Cauffman; Faisal Aziz; John F Radtka; David N Proctor; Urs A Leuenberger; Lawrence I Sinoway; Matthew D Muller Journal: Ann Vasc Surg Date: 2016-08-27 Impact factor: 1.466
Authors: Attila Nemes; Erika Balázs; Osama I I Soliman; Róbert Sepp; Miklós Csanády; Tamás Forster Journal: Heart Vessels Date: 2009-09-27 Impact factor: 2.037
Authors: Sophie I Mavrogeni; George Markousis-Mavrogenis; David Heutemann; Kees van Wijk; Hans J Reiber; Genovefa Kolovou Journal: World J Methodol Date: 2015-09-26