title: Quantification of coronary flow reserve in patients with ischaemic and non-ischaemic cardiomyopathy and its association with clinical outcomes.
abstract: OBJECTIVE
  Patients with left ventricular systolic dysfunction frequently show abnormal coronary vascular function, even in the absence of overt coronary artery disease. Moreover, the severity of vascular dysfunction might be related to the aetiology of cardiomyopathy.We sought to determine the incremental value of assessing coronary vascular dysfunction among patients with ischaemic (ICM) and non-ischaemic (NICM) cardiomyopathy at risk for adverse cardiovascular outcomes.
  
  
  RESULTS
  Coronary flow reserve (CFR, stress/rest myocardial blood flow) was quantified in 510 consecutive patients with rest left ventricular ejection fraction (LVEF) ≤45% referred for rest/stress myocardial perfusion PET imaging. The primary end point was a composite of major adverse cardiovascular events (MACE) including cardiac death, heart failure hospitalization, late revascularization, and aborted sudden cardiac death.Median follow-up was 8.2 months. Cox proportional hazards model was used to adjust for clinical variables. The annualized MACE rate was 26.3%. Patients in the lowest two tertiles of CFR (CFR ≤ 1.65) experienced higher MACE rates than those in the highest tertile (32.6 vs. 15.5% per year, respectively, P = 0.004), irrespective of aetiology of cardiomyopathy.
  
  
  CONCLUSIONS
  Impaired coronary vascular function, as assessed by reduced CFR by PET imaging, is common in patients with both ischaemic and non-ischaemic cardiomyopathy and is associated with MACE.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Maulik D
authors.initials: MD
authors.lastname: Majmudar
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Divisions of Nuclear Medicine and Cardiothoracic Imaging, Department of Radiology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Venkatesh L
authors.initials: VL
authors.lastname: Murthy
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Ravi V
authors.initials: RV
authors.lastname: Shah
authors.affiliation: Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Swathy
authors.initials: S
authors.lastname: Kolli
authors.affiliation: Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Negareh
authors.initials: N
authors.lastname: Mousavi
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Foster
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Jon
authors.initials: J
authors.lastname: Hainer
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA.
authors.forename: Ron
authors.initials: R
authors.lastname: Blankstein
authors.affiliation: Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Sharmila
authors.initials: S
authors.lastname: Dorbala
authors.affiliation: Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Sitek
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA.
authors.forename: Lynne W
authors.initials: LW
authors.lastname: Stevenson
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA.
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, ASB-L1 037C, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Non-Invasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA mdicarli@partners.org.
authors.forename: Marcelo F
authors.initials: MF
authors.lastname: Di Carli
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004562:Electrocardiography; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055414:Myocardial Perfusion Imaging / Q000379:methods*; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*
keywords: cardiomyopathy; clinical outcomes; coronary flow reserve; coronary vascular dysfunction; myocardial blood flow; positron emission tomography