Association of cerebral blood flow with the development of cardiac death or urgent heart transplantation in patients with systolic heart failure

Although cerebral blood flow (CBF) is known to be low in patients with advanced systolic heart failure (HF), little is known of the prognostic significance of this observation. We investigated whether CBF might be associated with the development of adverse outcomes in systolic HF, and whether it might provide prognostic information in addition to that provided by exercise tests.

We performed a prospective observational study involving 224 systolic HF patients (left ventricular ejection fraction ≤35%). The study endpoint was the occurrence of cardiac death or urgent heart transplantation. Global CBF was measured using radionuclide angiography. Clinical, biochemical, echocardiographic, and exercise data were also obtained. During follow-up (median 36 months), 52 patients experienced death or urgent transplantation. Multivariable analysis showed that global CBF, the minute ventilation/carbon dioxide production (VE/VCO₂) slope, New York Heart Association functional class ≥III, symptom duration ≥12 months, serum sodium, and serum creatinine were associated with the development of the endpoint. Patients with a CBF <35.4 mL/min/100 g were at increased risk of death or urgent transplantation (hazard ratio = 2.47; 95% confidence interval, 1.35–4.52). The addition of global CBF to a prognostic model including the VE/VCO₂ slope increased the C-index for the prediction of adverse outcomes with borderline significance.

Cerebral blood flow was associated with the development of long-term outcomes in systolic HF, and therefore may be useful in identifying patients suitable for heart transplantation. This finding is especially relevant for patients in whom exercise tests may not be performed sufficiently.