Maulik D Majmudar1, Venkatesh L Murthy2, Ravi V Shah1, Swathy Kolli3, Negareh Mousavi3, Courtney R Foster4, Jon Hainer4, Ron Blankstein5, Sharmila Dorbala6, Arkadiusz Sitek4, Lynne W Stevenson5, Mandeep R Mehra5, Marcelo F Di Carli7. 1. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. 2. Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA. 3. Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. 4. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. 5. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA. 6. Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA. 7. Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA mdicarli@partners.org.
Abstract
AIMS: Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy.We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes. METHODS AND RESULTS: Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death.Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy. CONCLUSION: Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy.We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes. METHODS AND RESULTS: Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death.Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy. CONCLUSION: Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE. Published on behalf of the European Society of Cardiology. All rights reserved.
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