Document Detail


The prognostic impact of coronary flow-reserve assessed by Doppler echocardiography in non-ischaemic dilated cardiomyopathy.
MedLine Citation:
PMID:  16464914     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Coronary flow-reserve (CFR) can be impaired in non-ischaemic dilated cardiomyopathy (DCM), unmasking a coronary microcirculatory dysfunction of potential prognostic impact. The aim of the present study is to evaluate the prognostic value of Doppler echocardiographic-derived CFR in patients with DCM. METHODS AND RESULTS: We evaluated 129 DCM patients (85 male; age 62+/-11) by transthoracic dipyridamole (0.84 mg/kg in 10 min) stress echocardiography. All patients had an ejection fraction<40% (mean 32+/-7) and angiographically normal coronary arteries with NYHA class<or=3. CFR was assessed on left anterior descending artery using pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. All patients were followed-up for a median of 22 months. Mean CFR was 2.0+/-0.5. At individual patient analysis 46 patients had normal (CFR>2.0) and 83 had abnormal CFR. During follow-up, 18 patients died and 33 showed worsening of NYHA class. The worse event-free survival was observed in those patients with an abnormal CFR when compared with those having a normal CFR at high dose of dipyridamole (70 vs. 22%, at 75 months of follow-up, P<0.0001). In the multivariable analysis, severity of mitral insufficiency (HR=1.9, 95% CI=1.06-2.87), abnormal CFR (HR=4.0, 95% CI=1.1-15.6), resting wall motion score index (HR=6.9, 95% CI=1.5-30.7) were independent predictors of survival. CONCLUSION: In DCM patients, CFR is often impaired. A reduced CFR during vasodilator stress is an independent prognostic marker of bad prognosis.
Authors:
Fausto Rigo; Sonia Gherardi; Maurizio Galderisi; Lorenza Pratali; Lauro Cortigiani; Rosa Sicari; Eugenio Picano
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Publication Detail:
Type:  Journal Article     Date:  2006-02-07
Journal Detail:
Title:  European heart journal     Volume:  27     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-06-01     Completed Date:  2007-02-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1319-23     Citation Subset:  IM    
Affiliation:
Cardiology Division, Umberto I Hospital, Mestre-Venice, and Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
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MeSH Terms
Descriptor/Qualifier:
Cardiomyopathy, Dilated / mortality,  physiopathology*,  ultrasonography
Coronary Circulation / physiology*
Echocardiography, Doppler
Echocardiography, Stress
Female
Follow-Up Studies
Humans
Male
Middle Aged
Stroke Volume / physiology
Survival Analysis
Comments/Corrections
Comment In:
Eur Heart J. 2006 Jun;27(11):1266-7   [PMID:  16682382 ]
Eur Heart J. 2006 Aug;27(15):1884; author reply 1884-5   [PMID:  16760201 ]
Eur Heart J. 2006 Nov;27(21):2607-8; author reply 2608-9   [PMID:  17030524 ]
Eur Heart J. 2006 Nov;27(21):2609; author reply 2609-10   [PMID:  17030520 ]

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