Functional, Anatomical, and Prognostic Correlates of Coronary Flow Velocity Reserve During Stress Echocardiography
| Autor: | Fausto Rigo, Iana Simova, Antonello D'Andrea, Pablo Merlo, Clarissa Borguezan Daros, Eugenio Picano, Alla A. Boshchenko, Eduardo Bossone, Suzana Gligorova, Fabio Marco Costantino, Nadezhda Zhuravskaya, Ana Djordjevic-Dikic, Albert Varga, Michele De Nes, Rodolfo Citro, Marco Antonio Rodrigues Torres, Marco Paterni, Dario Gregori, Milica Dekleva, Maria Chiara Scali, Angela Zagatina, Sergio Severino, Alessandro Salustri, Clara Carpeggiani, Lauro Cortigiani, Alexander V. Vrublevsky, Fabio Lattanzi, Paolo Colonna, Ines Monte, Quirino Ciampi, Hugo Rodríguez-Zanella, Jorge Lowenstein, Jarosław D. Kasprzak, Nicola Gaibazzi, Claudio Dodi, José Luis de Castro e Silva Pretto, Karina Wierzbowska-Drabik, Miguel Amor |
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| Přispěvatelé: | Ciampi, Q., Zagatina, A., Cortigiani, L., Gaibazzi, N., Borguezan Daros, C., Zhuravskaya, N., Wierzbowska-Drabik, K., Kasprzak, J. D., de Castro e Silva Pretto, J. L., D'Andrea, A., Djordjevic-Dikic, A., Monte, I., Simova, I., Boshchenko, A., Citro, R., Amor, M., Merlo, P. M., Dodi, C., Rigo, F., Gligorova, S., Dekleva, M., Severino, S., Lattanzi, F., Scali, M. C., Vrublevsky, A., Torres, M. A. R., Salustri, A., Rodriguez-Zanella, H., Costantino, F. M., Varga, A., Bossone, E., Colonna, P., De Nes, M., Paterni, M., Carpeggiani, C., Lowenstein, J., Gregori, D., Picano, E. |
| Rok vydání: | 2019 |
| Předmět: |
Male
coronary artery disease coronary flow velocity reserve heart failure lung ultrasound stress echocardiography medicine.medical_specialty Diastole 030204 cardiovascular system & hematology Anterior Descending Coronary Artery Coronary artery disease 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Stress Echocardiography Humans Prospective Studies 030212 general & internal medicine Aged Ejection fraction business.industry Odds ratio Middle Aged Prognosis medicine.disease 3. Good health Fractional Flow Reserve Myocardial Heart failure Cardiology Female Dobutamine Cardiology and Cardiovascular Medicine business Blood Flow Velocity Echocardiography Stress medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 74:2278-2291 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2019.08.1046 |
| Popis: | Background: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). Objectives: The purpose of this study was to assess the feasibility and functional correlates of CFVR. Methods: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. Results: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. Conclusions: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome. |
| Databáze: | OpenAIRE |
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