Background: Cerebral blood flow (CBF) at rest is decreased in the advanced stage of heart failure (HF). However, little is known about the prognostic significance of global CBF in patients with advanced HF. Methods: We studied 111 patients with advanced HF (LVEF ���35%) between Dec 2002 and Aug 2008. Global CBF was measured by radionuclide angiography. Echocardiography and symptom-limited bicycle exercise testing were performed within 1 week after CBF examination. Serum B-type natriuretic peptide (BNP) level test was performed just before discharge or in outpatient department. All patients were followed for >9months. The end point was death or urgent transplantation (KONOS status 1). Results: The median age was 44.6짹12.6 years. Peak VO₂ was 20.7짹5.3 ml/kg/min and LVEF was 21.0짹6.5%. In a Cox univariate analysis, CBF, body mass index, NYHA class (���3), peak VO₂, VE/VCO₂, BNP level, and a history of atrial fibrillation were the variables related to death or urgent transplantation. In a multivariate analysis, CBF (Hazard Ratio, HR, 0.49; p=0.021), BNP level (HR, 1.01; p=0.040), and a history of atrial fibrillation (HR, 11.16; p=0.021) were independent predictors of death or urgent transplantation. In ROC analysis, a CBF of 36 ml/min/100g showed 81% sensitivity and 63% specificity (ROC area, 0.799; 95% CI, 0.73-0.87) to predict death or urgent transplantation. Kaplan-Meier curves are shown in figure. Conclusion: The measurement of global CBF is helpful in predicting the long-term outcomes of advanced HF and may therefore be valuable in selecting recipients for urgent transplantation.