The prognostic value of Doppler echocardiographic-derived coronary flow reserve is not affected by concomitant antiischemic therapy at the time of testing
| Autor: | Lauro Cortigiani, Rosa Sicari, Sonia Gherardi, Eugenio Picano, Maurizio Galderisi, Fausto Rigo |
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| Rok vydání: | 2008 |
| Předmět: |
Male
medicine.medical_specialty Adrenergic beta-Antagonists Myocardial Ischemia Coronary Artery Disease Kaplan-Meier Estimate Coronary artery disease Coronary circulation Predictive Value of Tests Coronary Circulation Internal medicine medicine Humans Prospective Studies Prospective cohort study Aged Nitrates business.industry Hazard ratio Coronary flow reserve Heart Middle Aged Calcium Channel Blockers medicine.disease Echocardiography Doppler Dipyridamole medicine.anatomical_structure Predictive value of tests Concomitant Cardiology Female Cardiology and Cardiovascular Medicine Nuclear medicine business Echocardiography Stress Follow-Up Studies medicine.drug |
| Zdroj: | American Heart Journal. 156:573-579 |
| ISSN: | 0002-8703 |
| Popis: | Background When wall motion abnormality is the diagnostic end point, concomitant antiischemic therapy heavily modulates the prognostic value of dipyridamole echocardiography test (DET). A negative test result is less benign, and a positive test result is more malignant if performed under therapy. Recently, coronary flow reserve (CFR) was added to wall motion in dual imaging DET. The aim of the study was to determine whether antianginal medications affect the prognostic value of Doppler echocardiographic-derived CFR in patients with known or suspected coronary artery disease undergoing DET. Methods In a prospective, multicenter, observational study, we evaluated 1,779 patients (1,072 males; 64 ± 11 years) who underwent high-dose dipyridamole (0.84 mg/kg for 6 minutes) stress echo with CFR evaluation of left anterior descending (LAD) artery by Doppler. Results Seven hundred thirty-three (41%) patients were on antiischemic therapy at time of testing (nitrates and/or calcium antagonists and/or β-blockers). Mean CFR was 2.3. ± 0.6. At individual patient analysis, 1,141 patients had normal (CFR >2.0) and 638 had abnormal (CFR ≤2.0) CFR on LAD. During a median follow-up of 36 months, 263 events occurred as follows: 36 deaths and 59 ST-elevation myocardial infarctions (STEMIs) and 168 non-STEMIs (NSTEMIs). Survival was highest in patients with normal CFR and lowest in patients with abnormal CFR (87% vs 34%, P = .0001). Survival was comparable in patients with normal CFR on and off therapy and in patients with abnormal CFR on and off therapy. At multivariable analysis, hypertension (hazard ratio [HR] 1.5, 95% CI 1.0-1.9, P = .010), DET positivity for regional wall motion abnormalities (HR 5.7, 95% CI 4.3-7.4, P = .000), an abnormal CFR on LAD (HR 3.3, 95% CI 2.5-4.4, P = .000) were independent prognostic predictors of hard cardiac events. Conclusion Ongoing antiischemic therapy at the time of testing does not modulate the prognostic value of Doppler echocardiographic-derived coronary flow reserve. |
| Databáze: | OpenAIRE |
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