Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure
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Published on: June 28, 2019
Brijesh Anantharam1, Raj Janardhanan, Sajad Hayat
1Department of Cardiology and Institute of Postgraduate Medical Education and Research, Northwick Park Hospital, Harrow HA1 3UJ, UK.
Insights
Myocardial contrast echocardiography (MCE) can assess coronary flow reserve (CFR) in heart failure patients. Low CFR is a powerful predictor of mortality, aiding risk stratification.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Heart failure poses a significant mortality risk.
- Predicting mortality in heart failure is crucial for patient management.
- Myocardial viability, ischemia, and coronary flow reserve (CFR) are known mortality predictors in heart failure.
Purpose of the Study:
- To evaluate if myocardial contrast echocardiography (MCE) can predict mortality in heart failure patients.
- To determine the prognostic value of MCE-assessed CFR in heart failure.
Main Methods:
- Eighty-seven heart failure patients underwent low-power MCE at rest and after dipyridamole stress.
- Quantitative CFR was calculated, and patients were followed for mortality.
- Coronary arteriography was performed, and independent predictors of mortality were identified.
Main Results:
- 49% of patients had coronary artery disease; 32% died during follow-up.
- Type 2 diabetes and CFR were independent predictors of mortality.
- A CFR ≤ 1.5 was associated with significantly higher mortality (49% vs. 10% for CFR > 1.5).
Conclusions:
- Coronary flow reserve (CFR) assessed by MCE is a powerful predictor of mortality in heart failure patients.
- MCE provides valuable prognostic information at the bedside.
Aims:
the aim of the study was to assess whether myocardial contrast echocardiography (MCE) can predict mortality in patients with heart failure. Myocardial viability, ischaemia, and coronary flow reserve (CFR) are predictors of mortality in patients with heart failure. MCE can assess myocardial viability, ischaemia, and CFR at the bedside. However, its prognostic value is unknown in patients with heart failure.
Methods And Results:
eighty-seven patients (age: 68 ± 10 years, 62% male) with heart failure [left ventricular ejection fraction (LVEF): 35% ± 13] underwent low-power intermittent MCE at rest and 2 min after dipyridamole infusion. Resting and stress perfusion score index were derived qualitatively. CFR (MBF at stress/MBF at rest) was calculated by a quantitative method. All patients underwent coronary arteriography. Patients were followed up for mortality. Of the 87 patients, 43 (49%) patients had coronary artery disease. There were 28 (32%) deaths during a mean follow-up of 4.1 ± 1.7 years. Type 2 diabetes [P = 0.02, hazard ratios (HR) 2.43, confidence interval (CI) 1.13-5.22] and CFR (P = 0.001, HR 0.15, CI 0.05-0.45) were independent predictors of mortality. A CFR ≤ 1.5 had a significantly (P < 0.0001) higher mortality of 49 vs. 10% in patients with CFR > 1.5 over the 4 year follow-up period.
Conclusion:
CFR determined by MCE is a powerful predictor of mortality in patients with heart failure.
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