AUTHOR=Ciampi Quirino , Cortigiani Lauro , Gaibazzi Nicola , Rigo Fausto , Zagatina Angela , Wierzbowska-Drabik Karina , Kasprzak Jaroslaw D. , Djordjevic-Dikic Ana , Haberka Maciej , Barbieri Andrea , Bartolacelli Ylenia , Pepi Mauro , Carerj Scipione , Villari Bruno , Pellikka Patricia A. , Picano Eugenio 

TITLE=Echocardiographic functional determinants of survival in heart failure with abnormal ejection fraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1290366

DOI=10.3389/fcvm.2023.1290366

ISSN=2297-055X

ABSTRACT=<sec><title>Background and Aims</title><p>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.</p></sec><sec><title>Methods and results</title><p>In a prospective multicenter study design, we enrolled 1,408 HF patients (age 66 ± 12 years, 1,035 men), with EF &lt;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 &lt;10% for CFV measurement. Baseline CFV (abnormal value &gt;31 cm/s) was obtained by pulsed-wave Doppler in mid-distal LAD. CFVR (abnormal value ≤2.0) was assessed with exercise (<italic>n</italic> = 99), dobutamine (<italic>n</italic> = 100), and vasodilator stress (dipyridamole in 1,149, adenosine in 60). Inducible myocardial ischemia was identified with wall motion score index (WMSI) stress &gt; rest (cut-off Δ ≥ 0.12). LV contractile reserve (CR) was identified with WMSI stress &lt; rest (cutoff Δ ≥ 0.25). Test response ranged from score 0 (EF &gt; 30%, CFV ≥ 32 cm/s, CFVR &gt; 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, <italic>p</italic> &lt; 0.0001), CFV (HR: 2.407, 95% CI: 1.871–3.096, <italic>p</italic> &lt; 0.001), CFVR (HR: 3.908, 95% CI: 2.903–5.260, <italic>p</italic> &lt; 0.001), stress-induced ischemia (HR: 2.223, 95% CI: 1.642–3.009, <italic>p</italic> &lt; 0.001), and LVCR (HR: 0.524, 95% CI: 0.324–.647, <italic>p </italic>= 0.008). The annual mortality rate was lowest (1.2%) in patients with a score of 0 (<italic>n </italic>= 61) and highest (31.9%) in patients with a score of 5 (<italic>n</italic> = 15, <italic>p </italic>&lt; 0.001).</p></sec><sec><title>Conclusion</title><p>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.</p></sec>