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Clinical and functional determinants of coronary flow reserve in non-ischemic dilated cardiomyopathy: an
Patricia Santagata1, Fausto Rigo, Sonia Gherardi
1CNR, Institute of Clinical Physiology, Via Moruzzi 1, 56124 Pisa, Italy.
Insights
Coronary flow reserve (CFR) is reduced in dilated cardiomyopathy (DCM) patients. NYHA functional class is the strongest predictor of this reduction, with lower CFR in more advanced classes.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Coronary flow reserve (CFR) is often impaired in non-ischemic dilated cardiomyopathy (DCM).
- Potential contributing factors include diastolic compressive forces, left ventricular hypertrophy, and microvascular disease, though mechanisms remain unclear.
Purpose of the Study:
- To investigate the determinants of CFR in patients with non-ischemic DCM.
- To identify key clinical and echocardiographic factors associated with reduced CFR in this population.
Main Methods:
- Evaluated 110 non-ischemic DCM patients and 21 controls using dipyridamole stress echocardiography.
- Assessed CFR on the left anterior descending artery (LAD) via pulsed Doppler, calculating the ratio of maximal vasodilation to rest peak diastolic coronary flow velocity.
- Correlated CFR with clinical parameters including NYHA functional class, ejection fraction, and pulmonary artery pressure.
Main Results:
- Non-ischemic DCM patients exhibited significantly lower mean CFR (2.0±0.6) compared to controls (3.2±0.5).
- Reduced CFR correlated with higher NYHA class, lower ejection fraction, increased end-systolic volume, higher pulmonary artery systolic pressure, and shorter deceleration time.
- Logistic multiregression identified NYHA functional class as the sole significant negative predictor of CFR (OR=0.9, p=0.0001).
Conclusions:
- CFR is reduced in non-ischemic DCM, displaying significant individual variability.
- NYHA functional class is the strongest clinical predictor of CFR reduction, indicating that disease severity is paramount.
- While systolic and diastolic dysfunction contribute, NYHA class better reflects CFR impairment in non-ischemic DCM.
Abstract:
Coronary flow reserve (CFR) is impaired in non-ischemic dilated cardiomyopathy (DCM). Mechanisms by which such impairment occurs are still unknown, but cofactors such as diastolic compressive force, left ventricular hypertrophy, and microvascular disease have been implied. In order to characterize the determinants of CFR in non-ischemic DCM, we evaluated 110 non-ischemic DCM patients (58 men; age=61+/-12 years) and 21 age- and gender-matched control patients (14 men; age=59+/-13 years) by transthoracic (n=88) or transesophageal (n=22) dipyridamole (0.84 mg/ kg in 10') stress echocardiography. All patients showed angiographically normal coronary arteries. Non-ischemic DCM patients had an ejection fraction <45% while control patients had normal left ventricular systolic function. CFR was assessed on LAD by pulsed Doppler as the ratio of maximal vasodilation (dipyridamole) to rest peak diastolic coronary flow velocity. Mean CFR value was 2.0+/-0.6 for DCM patients and 3.2+/-0.5 for controls (p<0.01). At individual non-ischemic DCM patient analysis, 46 patients had normal CFR> or =2 (Group 1) and 64 patients had abnormal CFR<2 (Group 2). On univariate analysis, CFR reduction correlated with NYHA functional class (r=-0.33, p=0.001), left ventricular ejection fraction ( r=0.23, p=0.02), end-systolic volume (r=-0.23, p=0.02), systolic pulmonary artery pressure (r=-0.42, p=0.0001), deceleration time (r=0.24, p=0.02). Logistic multiregression analysis showed that only NYHA functional class significantly and negatively correlated with CFR (odds ratio=0.9; 95% confidence intervals: 0.03-.35, p=0.0001). In patients with non-ischemic DCM, CFR is reduced but with substantial individual variability, only partially accounted for by level of systolic and diastolic dysfunction. The clinical functional class is the strongest predictor of CFR reduction in these patients, with lowest flow reserve found in more advanced NYHA class.
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