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Published on: April 13, 2015
The additive prognostic value of wall motion abnormalities and coronary flow reserve during dipyridamole stress echo
Fausto Rigo1, Rosa Sicari, Sonia Gherardi
1Cardiology Division, Umberto I Hospital, Mestre-Venice, Italy.
Insights
Coronary flow reserve (CFR) and dipyridamole echocardiography test (DET) wall motion criteria are additive in predicting cardiac events in patients with coronary artery disease (CAD). Combining these assessments improves risk identification for hard cardiac events.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Echocardiography
Background:
- Coronary artery disease (CAD) diagnosis and risk stratification are crucial for patient management.
- Dipyridamole echocardiography test (DET) assesses myocardial ischemia through wall motion abnormalities.
- Coronary flow reserve (CFR), derived from Doppler echocardiography, quantifies microvascular function.
Purpose of the Study:
- To evaluate the prognostic value of Doppler echocardiographic-derived CFR compared to regional wall motion analysis in patients with known or suspected CAD undergoing DET.
- To determine if CFR and wall motion criteria are additive in predicting hard cardiac events.
Main Methods:
- A prospective, multicentre, observational study involving 1145 patients with known or suspected CAD.
- High-dose dipyridamole stress echocardiography with Doppler assessment of left anterior descending (LAD) coronary flow reserve (CFR).
- Patients were followed for a median of 27 months for hard cardiac events (death, myocardial infarction, unstable angina).
Main Results:
- DET was positive for wall motion abnormalities in 25% and negative in 74% of patients.
- Mean CFR was 2.2 ± 0.5, with 702 patients having normal CFR (>2.0) and 443 abnormal CFR.
- Multivariable analysis identified CFR on LAD, medical therapy, DET positivity, and angina on effort as independent predictors of hard cardiac events.
Conclusions:
- In patients with known or suspected CAD, DET results by wall motion criteria and CFR are additive and complementary.
- Combining DET wall motion assessment and CFR improves the identification of patients at high risk for hard cardiac events.
Aims:
The aim of the study was to evaluate the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) over regional wall motion in patients with known or suspected coronary artery disease (CAD) undergoing dipyridamole echocardiography test (DET).
Methods And Results:
In a prospective, multicentre, observational study, we evaluated 1145 patients (702 males; 64 +/- 11 years) who underwent high-dose dipyridamole (0.84 mg/kg over 6 min) stress echo with CFR evaluation of LAD by Doppler. DET was positive for regional wall motion abnormalities in 291 (25%) and negative in 854 (74%) patients. Mean CFR was 2.2 +/- 0.5. At individual patient analysis 702 patients had normal (CFR > 2.0) and 443 had abnormal CFR on LAD. During a median follow-up of 27 months, 109 events occurred: 16 deaths, 17 non-fatal myocardial infarctions, 76 re-hospitalizations for unstable angina. The 30 months infarction-free survival showed the best outcome for those patients with negative DET by wall motion criteria and normal CFR and the worst outcome for patients with positive DET by wall motion and abnormal CFR (99 vs. 68%, P < 0.001). At multivariable analysis, CFR on LAD [hazard ratio (HR) 2.4, 95% CI 1.1-5.4, P = 0.030], medical therapy at time of testing (HR 2.8, 95% CI 1.2-6.6, P = 0.022), DET positivity for regional wall motion abnormalities (HR 3.6, 95% CI 1.5-8.7, P = 0.000), and angina on effort (HR 6.3, 95% CI 2.7-14.8, P = 0.000) were independent prognostic predictors of hard cardiac events.
Conclusion:
In patients with known or suspected CAD, DET result by wall motion criteria and CFR are additive and complementary for the identification of patients at risk of experiencing hard events.
