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Background: Coronary flow reserve (CFR) on left anterior descending (LAD) can be reduced in non-ischemic dilated cardiomyopathy (DCM). Pressure-volume relationship (PVR) is a useful method for evaluating LV myocardial contractility during stress echocardiography (SE). Aim: to assess the relationship between CFR on LAD and PVR in DCM patients.Methods: Sixty DCM patients (36 men; 63±13 years, mean value of ejection fraction: 36±7%) underwent dipyridamole stress echo (dypSE, 0.84 mg/kg in 6'). CFR was defined as the ratio between maximal vasodilation and rest peak diastolic flow velocity in LAD. PVR was defined as systolic cuff pressure/end-systolic volume index difference between rest-peak dypSE.Results: PVR was inversely related to wall motion score index at rest (r=-.424, p=.001) and at peak dypSE (r=-.528, p<.001), and directly related to E wave deceleration time (r=.365, p=.014). PVR was not related to ejection fraction at rest, and directly related to ejection fraction at peak dypSE (r=.482, p<.001). CFR on LAD was abnormal (<2) in 25/60 (42%) patients. PVR was directly related to CFR on LAD (r=.412, p=.001, Figure).Conclusions: In DCM patients, the presence of myocardial contractile reserve is directly related to CFR on LAD.