Reduced coronary flow reserve in patients with congestive heart failure assessed by transthoracic Doppler echocardiography

https://doi.org/10.1016/j.echo.2004.08.007Get rights and content

Background

Although coronary flow reserve (CFR) has been reported to be restricted in various conditions, there has been no report of CFR for patients with congestive heart failure (CHF). The purpose of this study was to assess coronary flow characteristics for patients with CHF.

Methods

We studied 15 patients with CHF: 8 with dilated myocardiopathy and 7 with hypertensive heart disease. Phasic coronary flow velocities were obtained in the left anterior descending coronary artery at rest and during hyperemia (0.15 mg/kg/min adenosine triphosphate infusion intravenously) by transthoracic echocardiography before and after treatment of CHF. CFR was obtained from the ratio of hyperemic/baseline diastolic mean velocity.

Results

CFR was significantly restricted in the condition of CHF compared with that after improvement of CHF (1.5 ± 0.2 vs 2.0 ± 0.3, P < .01). Baseline diastolic mean velocity in the condition with CHF was significantly greater than that after improvement of CHF (41 ± 13 cm/s vs 33 ± 13 cm/s, P = .04), although maximal hyperemic diastolic mean velocity was not significantly different before and after improvement of CHF (63 ± 20 cm/s vs 61 ± 19 cm/s, P = .68). After improvement of CHF, heart rate, along with left ventricular end-diastolic volume and dimension, were significantly decreased, and deceleration time of transmitral early filling flow was increased compared with before treatment of CHF. Blood pressure and ejection fraction were not significantly different before and after treatment of CHF.

Conclusions

Restriction of CFR is demonstrated during CHF because of the elevation of baseline resting flow velocity, which might be related to increase in left ventricular preload and heart rate.

Section snippets

Patients

In all, 15 patients (6 men, 9 women) with CHF were included in this study. Of these, 7 patients had dilated cardiomyopathy (DCM) and the remaining 8 patients had hypertensive heart disease (HHD). Patient age ranged from 39 to 81 years with a mean age of 64 ± 14 years. All patients had orthopnea at the time of admission and chest radiograph revealed lung congestion. Patients with atrial fibrillation, using catecholamine, and undergoing intubation were excluded from this study. All patients

Echocardiographic data

The echocardiographic data in both conditions before and after improvement of CHF are presented in Table 1. Although there were no significant differences in LVEF before and after improvement of CHF, LVDd, LV end-systolic dimension, LVEDV, and LV end-systolic volume were significantly greater during CHF compared with after improvement of CHF (Table 1). Furthermore, LV-DT was significantly shorter during CHF compared with after improvement of CHF (Table 1).

CFV data and hemodynamic data

Coronary flow and CFV data in both

Discussion

In this study, we demonstrated that CFR was restricted for patients with CHF because of an increase in basal MDV of the coronary flow. Reduction of CFR changed for the better after improvement of CHF, because basal mean diastolic CFV was reduced without any change in maximal hyperemic mean diastolic CFV. LV preload, which was demonstrated by the size of LVDd and LVEDV, was also significantly reduced after improvement of CHF, but there was no significant difference in LVEF. HR became lower

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