AUTHOR=Ciampi Quirino , Cortigiani Lauro , Gaibazzi Nicola , Rigo Fausto , Zagatina Angela , Wierzbowska-Drabik Karina , Kasprzak Jaroslaw D. , Djordjevic-Dikic Ana , Haberka Maciej , Barbieri Andrea , Bartolacelli Ylenia , Pepi Mauro , Carerj Scipione , Villari Bruno , Pellikka Patricia A. , Picano Eugenio 

TITLE=Echocardiographic functional determinants of survival in heart failure with abnormal ejection fraction

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1290366

DOI=10.3389/fcvm.2023.1290366

ISSN=2297-055X

ABSTRACT=Background and Aims. Patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (EF) have a heterogeneous prognosis, and assessment of coronary physiology with coronary flow velocity (CFV) and coronary flow velocity reserve (CFVR) may complement established predictors based on wall motion and EF.In a prospective multicenter study design, we enrolled 1,408 HF patients (age 66±12 years, 1,035 men), with EF <50%, 743 (53%) with coronary artery disease, and 665 (47%) with normal coronary arteries. Recruitment (years 2004-2022) involved 8 accredited laboratories, with inter-observer variability <10% for CFV measurement. Baseline CFV (abnormal value >31 cm/s) was obtained by pulsed-wave Doppler in mid-distal LAD. CFVR (abnormal value ≤2.0) was assessed with exercise (n=99), dobutamine (n=100), and vasodilator stress (dipyridamole in 1,149, adenosine in 60). Inducible myocardial ischemia was identified with wall motion score index (WMSI) stress> rest (cut-off ∆≥0.12). LV contractile reserve (CR) was identified with WMSI stress< rest (cutoff ∆≥0.25). Test response ranged from score 0 (EF>30%, CFV ≥32 cm/s, CFVR>2.0, LVCR present, ischemia absent) to score 5 (all steps abnormal). All-cause death was the only endpoint.Results. During a median follow-up of 990 days, 253 patients died. Independent predictors of death