{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T15:49:50Z","timestamp":1753890590598,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T00:00:00Z","timestamp":1700524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>In a prospective multicenter study design, we enrolled 1,408 HF patients (age 66\u2009\u00b1\u200912 years, 1,035 men), with EF &amp;lt;50%, 743 (53%) with coronary artery disease, and 665 (47%) with normal coronary arteries. Recruitment (years 2004\u20132022) involved 8 accredited laboratories, with inter-observer variability &amp;lt;10% for CFV measurement. Baseline CFV (abnormal value &amp;gt;31\u2005cm\/s) was obtained by pulsed-wave Doppler in mid-distal LAD. CFVR (abnormal value \u22642.0) was assessed with exercise (<jats:italic>n<\/jats:italic>\u2009=\u200999), dobutamine (<jats:italic>n<\/jats:italic>\u2009=\u2009100), and vasodilator stress (dipyridamole in 1,149, adenosine in 60). Inducible myocardial ischemia was identified with wall motion score index (WMSI) stress\u2009&amp;gt;\u2009rest (cut-off \u0394\u2009\u2265\u20090.12). LV contractile reserve (CR) was identified with WMSI stress\u2009&amp;lt;\u2009rest (cutoff \u0394\u2009\u2265\u20090.25). Test response ranged from score 0 (EF\u2009&amp;gt;\u200930%, CFV\u2009\u2265\u200932\u2005cm\/s, CFVR\u2009&amp;gt;\u20092.0, 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 were EF (HR: 0.956, 95% CI: 0.943\u20130.968, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001), CFV (HR: 2.407, 95% CI: 1.871\u20133.096, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), CFVR (HR: 3.908, 95% CI: 2.903\u20135.260, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), stress-induced ischemia (HR: 2.223, 95% CI: 1.642\u20133.009, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001), and LVCR (HR: 0.524, 95% CI: 0.324\u2013.647, <jats:italic>p\u2009<\/jats:italic>=\u20090.008). The annual mortality rate was lowest (1.2%) in patients with a score of 0 (<jats:italic>n\u2009<\/jats:italic>=\u200961) and highest (31.9%) in patients with a score of 5 (<jats:italic>n<\/jats:italic>\u2009=\u200915, <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High resting CFV is associated with worse survival in ischemic and nonischemic HF with reduced EF. The value is independent and additive to resting EF, CFVR, LVCR, and inducible ischemia.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1290366","type":"journal-article","created":{"date-parts":[[2023,11,22]],"date-time":"2023-11-22T15:07:17Z","timestamp":1700665637000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Echocardiographic functional determinants of survival in heart failure with abnormal ejection 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