Circulation. 2002;105:186-193
doi: 10.1161/hc0202.102119
doi: 10.1161/hc0202.102119
(Circulation. 2002;105:186.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Prognostic Role of Myocardial Blood Flow Impairment in Idiopathic Left Ventricular Dysfunction
From the C.N.R. Institute of Clinical Physiology, Pisa, Italy; Ospedale Civile Tabarracci, Viareggio, Italy (R.P.); and C.N.R. Institute of Clinical Physiology, Milan, Italy (O.P.).
Correspondence to Danilo Neglia, CNR Institute of Clinical Physiology, Via G Moruzzi, 1, 56126 Pisa, Italy. E-mail dneglia{at}ifc.pi.cnr.it
Background— Depressed myocardial blood flow (MBF) has been reported in dilated cardiomyopathy. The aim of this study was to investigate whether MBF impairment is an independent predictor of prognosis in patients with idiopathic left ventricular (LV) dysfunction.
Methods and Results— Sixty-seven patients (52 male, mean age 52±12 years) with different degrees of idiopathic LV systolic dysfunction (average LV ejection fraction, 0.34±0.10; range, 0.07 to 0.49) were prospectively enrolled. Thirty-four subjects (51%) had no history of heart failure symptoms at enrollment (NYHA class I). All patients underwent clinical and functional evaluation and a PET study to measure absolute MBF at rest and after intravenous dipyridamole. During a mean follow-up of 45±37 months, 24 patients had major cardiac events, including cardiac death in 8 and development or progression of heart failure in 16 patients. Multivariate regression analysis (Cox proportional hazards model) revealed heart rate (
2 11.06, P<0.001), LV end-diastolic dimension (2 11.73, P<0.001), and dipyridamole MBF (2 11.04, P<0.001) as independent predictors of subsequent cardiac events. Dipyridamole MBF 
1.36 mL · min-1 · g-1 was associated with an increase in the relative risk of death, development, or progression of heart failure of 3.5 times over other more common clinical and functional variables.
Conclusions— The present study demonstrates that severely depressed MBF is a predictor of poor prognosis in patients with idiopathic LV dysfunction independently of the degree of LV functional impairment and of the presence of overt heart failure.
Key Words: cardiomyopathy • microcirculation • prognosis
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|
|
|
|
 |
|
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|
|
|
|
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|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
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|
|
|
|
 |
|
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|
|
|
|
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|
|
|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
A. Lerman and A. M. Zeiher Endothelial Function: Cardiac Events Circulation, January 25, 2005; 111(3): 363 - 368. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
P. A. Kaufmann and P. G. Camici Myocardial Blood Flow Measurement by PET: Technical Aspects and Clinical Applications J. Nucl. Med., January 1, 2005; 46(1): 75 - 88. [Full Text] [PDF]
|
|
|
|
|
|
D. Fischer, S. Rossa, U. Landmesser, S. Spiekermann, N. Engberding, B. Hornig, and H. Drexler Endothelial dysfunction in patients with chronic heart failure is independently associated with increased incidence of hospitalization, cardiac transplantation, or death Eur. Heart J., January 1, 2005; 26(1): 65 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. I. Skalidis, F. I. Parthenakis, A. P. Patrianakos, M. I. Hamilos, and P. E. Vardas Regional coronary flow and contractile reserve in patients with idiopathic dilated cardiomyopathy J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2027 - 2032. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
U. Landmesser and H. Drexler Allopurinol and Endothelial Function in Heart Failure: Future or Fantasy? Circulation, July 9, 2002; 106(2): 173 - 175. [Full Text] [PDF]
|
|
|
|
 |
|
 A. F.M van den Heuvel, J. J Bax, P. K Blanksma, W. Vaalburg, H. J.G.M Crijns, and D. J van Veldhuisen Abnormalities in myocardial contractility, metabolism and perfusion reserve in non-stenotic coronary segments in heart failure patients Cardiovasc Res, July 1, 2002; 55(1): 97 - 103. [Abstract] [Full Text] [PDF]
|
|