Assessment of Coronary Flow Reserve in Heart Failure Patients After Ultrafiltration Versus Diuretics

Inclusion Criteria: * males and non-pregnant female patients over 18 years admitted to the hospital or treated in an outpatient heart failure clinic with the primary diagnosis of acute decompensated heart failure. * evidence of fluid overload more than 8 kg above their dry weight, and conforming to definition of hypervolemia (at least two of the following findings: more than 1+ pitting edema of the lower extremities, jugular venous pressure more than 10 cm water, pulmonary edema or pleural effusion on chest radiograph consistent with ADHF, ascites, paroxysmal nocturnal dyspnea, or equal or more than 2 pillow orthopnea. Exclusion Criteria: * acute coronary syndrome * documented ischemic cardiomyopathy * atrial fibrillation * serum creatinine more than 3.0 mg/dL * systolic blood pressure less than 90 mmHg * hematocrit \> 45% * clinical instability likely to require intravenous vasopressors and/or intravenous vasoactive drugs (such as milrinone, dobutamine, nitroglycerin or nesiritide) during the present hospitalization * severe pulmonary hypertension or use of pulmonary hypertension drugs (such as sildenafil, bosentan or other endothelin inhibitors) * patients with documented hypertrophic obstructive cardiomyopathy or restrictive cardiomyopathy, * patients with severe valvular heart disease, * patients with recent cocaine use (within one month of presentation) * patients with heart transplant * patients with systemic infection * patients on hemodialysis * inability to obtain venous access * contraindications for anticoagulation * unable to lie flat for at least 20 minutes * pregnant and breast-feeding women.