The additive prognostic value of wall motion abnormalities and coronary flow reserve during dipyridamole stress echo

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.