title: Association of cerebral blood flow with the development of cardiac death or urgent heart transplantation in patients with systolic heart failure.
abstract: OBJECTIVE
  Although cerebral blood flow (CBF) is known to be low in patients with advanced systolic heart failure (HF), little is known of the prognostic significance of this observation. We investigated whether CBF might be associated with the development of adverse outcomes in systolic HF, and whether it might provide prognostic information in addition to that provided by exercise tests.
  
  
  RESULTS
  We performed a prospective observational study involving 224 systolic HF patients (left ventricular ejection fraction ≤35%). The study endpoint was the occurrence of cardiac death or urgent heart transplantation. Global CBF was measured using radionuclide angiography. Clinical, biochemical, echocardiographic, and exercise data were also obtained. During follow-up (median 36 months), 52 patients experienced death or urgent transplantation. Multivariable analysis showed that global CBF, the minute ventilation/carbon dioxide production (VE/VCO(2)) slope, New York Heart Association functional class ≥III, symptom duration ≥12 months, serum sodium, and serum creatinine were associated with the development of the endpoint. Patients with a CBF <35.4 mL/min/100 g were at increased risk of death or urgent transplantation (hazard ratio = 2.47; 95% confidence interval, 1.35-4.52). The addition of global CBF to a prognostic model including the VE/VCO(2) slope increased the C-index for the prediction of adverse outcomes with borderline significance.
  
  
  CONCLUSIONS
  Cerebral blood flow was associated with the development of long-term outcomes in systolic HF, and therefore may be useful in identifying patients suitable for heart transplantation. This finding is especially relevant for patients in whom exercise tests may not be performed sufficiently.
authors: Heart Failure and Cardiac Transplantation Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, 388-1 Poongnap-dong, Songpa-gu, Seoul, Korea.
authors: Min-Seok
authors: MS
authors: Kim
authors: Jae-Seung
authors: JS
authors: Kim
authors: Sung-Cheol
authors: SC
authors: Yun
authors: Cheol-Whan
authors: CW
authors: Lee
authors: Jae-Kwan
authors: JK
authors: Song
authors: Seong-Wook
authors: SW
authors: Park
authors: Seung-Jung
authors: SJ
authors: Park
authors: Jae-Joong
authors: JJ
authors: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D002245:Carbon Dioxide / Q000032:analysis; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004452:Echocardiography; D004638:Emergency Treatment; D005080:Exercise Test; D005260:Female; D054143:Heart Failure, Systolic / Q000503:physiopathology* / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide