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Impaired coronary flow reserve in patients with supra-normal left ventricular ejection fraction at rest
Ping Wu1,2, Xiaoli Zhang3, Zhifang Wu1,2
1Department of Nuclear Medicine, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Insights
Supra-normal left ventricular ejection fraction (snLVEF) is linked to impaired coronary flow reserve (CFR) and increased major adverse cardiac events (MACE) in patients without severe cardiovascular disease. This suggests snLVEF may indicate underlying cardiac issues despite preserved ejection fraction.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Cardiovascular Imaging
Background:
- A "U" hazard ratio curve between left ventricular ejection fraction (LVEF) and prognosis is observed in echocardiography patients.
- The relationship between LVEF, coronary flow reserve (CFR), and prognosis in patients without severe cardiovascular disease (CVD) requires further investigation.
Purpose of the Study:
- To investigate the association between resting LVEF and CFR in patients without severe CVD.
- To determine if impaired CFR contributes to adverse outcomes in patients with supra-normal LVEF (snLVEF).
Main Methods:
- 210 patients without severe CVD underwent rest/dipyridamole stress 13N-ammonia PET/CT.
- Major adverse cardiac events (MACE) were tracked for 27.3 months.
- Resting LVEF, corrected CFR (cCFR), and MACE were analyzed using statistical models.
Main Results:
- An inverted "U" curve was observed between resting LVEF and cCFR (p=0.06).
- Both snLVEF (≥65%) and reduced LVEF (<55%) groups showed higher rates of reduced cCFR compared to normal LVEF (55-65%).
- snLVEF and reduced LVEF were independent predictors of reduced cCFR; snLVEF patients had more MACE.
Conclusions:
- Supra-normal LVEF is associated with impaired CFR and potentially adverse prognosis.
- Further research is needed to elucidate the pathological mechanisms and clinical significance of snLVEF in relation to CFR and outcomes.
Purpose:
Recently, a "U" hazard ratio curve between resting left ventricular ejection fraction (LVEF) and prognosis has been observed in patients referred for routine clinical echocardiograms. The present study sought to explore whether a similar "U" curve existed between resting LVEF and coronary flow reserve (CFR) in patients without severe cardiovascular disease (CVD) and whether impaired CFR played a role in the adverse outcome of patients with supra-normal LVEF (snLVEF, LVEF ≥ 65%).
Methods:
Two hundred ten consecutive patients (mean age 52.3 ± 9.3 years, 104 women) without severe CVD underwent clinically indicated rest/dipyridamole stress electrocardiography (ECG)-gated 13 N-ammonia positron emission tomography/computed tomography (PET/CT). Major adverse cardiac events (MACE) were followed up for 27.3 ± 9.5 months, including heart failure, late revascularization, re-hospitalization, and re-coronary angiography for any cardiac reason. Clinical characteristics, corrected CFR (cCFR), and MACE were compared among the three groups categorized by resting LVEF detected by PET/CT. Dose-response analyses using restricted cubic spline (RCS) functions, multivariate logistic regression, and Kaplan-Meier survival analysis were conducted to evaluate the relationship between resting LVEF and CFR/outcome.
Results:
An inverted "U" curve existed between resting LVEF and cCFR (p = 0.06). Both patients with snLVEF (n = 38) and with reduced LVEF (rLVEF, LVEF < 55%) (n = 66) displayed a higher incidence of reduced cCFR than those with normal LVEF (nLVEF, 55% ≤ LVEF < 65%) (n = 106) (57.9% vs 54.5% vs 34.3%, p < 0.01, respectively). Both snLVEF (p < 0.01) and rLVEF (p < 0.05) remained independent predictors for reduced cCFR after multivariable adjustment. Patients with snLVEF encountered more MACE than those with nLVEF (10.5% vs 0.9%, log-rank p = 0.01).
Conclusions:
Patients with snLVEF are prone to impaired cCFR, which may be related to the adverse prognosis. Further investigations are warranted to explore its underlying pathological mechanism and clinical significance.
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