First time description of cCFR changes with changing LVEF at rest

In a research cooperation between the Division of Nuclear Medicine of the MeduniWien, Taiyuan, China and Beijing, China, the trend of cCFR with changing LVEF at rest was depicted for the first time.

Recently, a “U” hazard ratio curve between resting left ventricular (LV) ejection fraction and prognosis has been observed in patients referred for routine clinical echocardiograms, abnormal LV ejection fraction (LVEF), not only reduced but also supra-normal LVEF (snLVEF), was correlated with adverse prognosis regardless of age, sex or other relevant comorbidities including heart failure (HF).

snLVEF is proposed as a new concept because of its newly observed long or short-term worse outcome in patients with acute or chronic coronary syndrome with or without HF and even in those without cardiac symptoms, such as old women, hypertension, tumor, sepsis, and serious anemia. Nevertheless, its pathological mechanism has not been clarified.

We explored the relationship between resting LVEF detected by PET/CT and corrected CFR (cCFR) as well as the role of cCFR in the adverse outcome of patients with snLVEF. In the milder cohort without severe cardiovascular disease (CVD), patients with snLVEF displayed a significant decrease of cCFR and a higher risk of MACE compared to those with normal LVEF; after multivariable analysis, patients with snLVEF had over 4 times and almost 2 times the risk of reduced cCFR than those with nLVEF and rLVEF, respectively.

This is the first study to depict the trend of cCFR with changing LVEF at rest, an inverted “U” curve was found between the two, with a peak at 55%-65%, and the slope of our plotted curve coincided with the aforementioned LVEF-prognosis curve reported recently in a large-sample clinical study including 203,135 patients.

These interesting findings suggest to some extent the potential prognostic value of coronary microvascular dysfunction in patients with snLVEF. This study provided further evidence to support the potential clinical and scientific value of snLVEF.

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