title: Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  CFR determined by MCE is a powerful predictor of mortality in patients with heart failure.
authors.affiliation: Department of Cardiology and Institute of Postgraduate Medical Education and Research, Northwick Park Hospital, Harrow HA1 3UJ, UK.
authors.forename: Brijesh
authors.initials: B
authors.lastname: Anantharam
authors.forename: Raj
authors.initials: R
authors.lastname: Janardhanan
authors.forename: Sajad
authors.initials: S
authors.lastname: Hayat
authors.forename: Michael
authors.initials: M
authors.lastname: Hickman
authors.forename: Navtej
authors.initials: N
authors.lastname: Chahal
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003326:Coronary Circulation; D004176:Dipyridamole; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole