Coronary flow reserve assessed by myocardial contrast echocardiography predicts mortality in patients with heart failure

Aims 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. Methods and 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. Conclusion CFR determined by MCE is a powerful predictor of mortality in patients with heart failure.