Introduction: Phase contrast (PC) cine MRI of the coronary sinus emerged as a non-invasive method
to quantify coronary flow reserve (CFR). Previous studies demonstrated that CFR was
substantially diminished in patients with heart failure with reduced ejection fraction
(HFrEF) and preserved ejection fraction (HFpEF). However, no data is available regarding
prognostic value of CFR for heart failure patients. Materials and Methods: Two hundred and forty nine heart failure patients were enrolled (68 HFrEF, 181 HFpEF).
CFR was calculated as myocardial blood flow (MBF) during adenosine triphosphate infusion
divided by MBF at rest using PC cine MRI of the coronary sinus. All cause death and
heart failure hospitalization were defined as event. Results: During a mean follow-up period of 30 ± 19 months, 13 deaths and 20 heart failure
hospitalization were identified. Multivariable Cox regression analysis demonstrated
that impaired CFR (CFR < 2.0) was independent prognostic marker both in HFrEF (hazard
ratio (HR): 5.22 (P < .001) and HFpEF (HR: 10.22 (P < .001)). Area under the ROC curve (AUC) of CFR for predicting event were 0.78 for
HFrEF and 0.88 for HFpEF. Conclusion: Higher HR and AUC of CFR observed in HFpEF than HFrEF indicated that CFR quantified
by PC cine MRI might be a non-invasive prognostic marker especially for HFpEF patients.
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