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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Coronary flow reserve during dipyridamole stress echocardiography predicts mortality
Lauro Cortigiani1, Fausto Rigo, Sonia Gherardi
1Cardiology Division, Campo di Marte Hospital, Lucca, Italy.
Insights
Coronary flow reserve (CFR) measured by Doppler echocardiography is a strong predictor of mortality in patients with coronary artery disease (CAD). A normal CFR indicates a low annual risk of death, even with abnormal stress tests.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Clinical Research
Background:
- Coronary flow reserve (CFR) using Doppler echocardiography of the left anterior descending artery is a key method in stress echocardiography.
- Assessing CFR provides critical insights into myocardial perfusion during vasodilatory stress.
Purpose of the Study:
- To determine if coronary flow reserve (CFR) can predict mortality in patients with known or suspected coronary artery disease (CAD).
- To compare the prognostic value of CFR against regional wall motion analysis.
Main Methods:
- A prospective, multicenter observational study involving 4,313 patients with known or suspected CAD.
- High-dose dipyridamole stress echocardiography with Doppler-based CFR assessment of the left anterior descending artery was performed.
- Overall mortality was the primary endpoint, with a median follow-up of 19 months.
Main Results:
- 18% of patients showed ischemia on stress echocardiography, and 33% had a CFR ≤2.
- Mortality was significantly higher in patients with CFR ≤2 compared to those with CFR >2, irrespective of ischemia status.
- Multivariable analysis identified CFR ≤2, ischemia, left bundle branch block, age, resting wall motion score index, male sex, and diabetes as independent predictors of mortality.
Conclusions:
- Coronary flow reserve (CFR) of the left anterior descending artery is a potent, independent predictor of mortality in patients with CAD.
- CFR offers additional prognostic information beyond wall motion analysis.
- A normal CFR on stress echocardiography is associated with an annual mortality risk below 1%.
Objectives:
The goal of this study was to evaluate the ability of coronary flow reserve (CFR) over regional wall motion to predict mortality in patients with known or suspected coronary artery disease (CAD).
Background:
CFR evaluated using pulsed Doppler echocardiography testing on left anterior descending artery is the state-of-the-art method during vasodilatory stress echocardiography.
Methods:
In a prospective, multicenter, observational study, we evaluated 4,313 patients (2,532 men; mean age 65 ± 11 years) with known (n = 1,547) or suspected (n = 2,766) CAD who underwent high-dose dipyridamole (0.84 mg/kg over 6 min) stress echocardiography with CFR evaluation of left coronary descending artery (LAD) by Doppler. Overall mortality was the only endpoint analyzed.
Results:
Stress echocardiography was positive for ischemia in 765 (18%) patients. Mean CFR was 2.35 ± 0.68. At individual patient analysis, 1,419 (33%) individuals had CFR ≤2. During a median follow-up of 19 months (1st quartile 8; 3rd quartile 36), 146 patients died. The 4-year mortality was markedly higher in subjects with CFR ≤2 than in those with CFR >2, both considering the group with ischemia (39% vs. 7%; p < 0.0001) and the group without ischemia at stress echocardiography (12% vs. 3%; p < 0.0001). At multivariable analysis, CFR on LAD ≤2 (hazard ratio [HR]: 3.31; 95% confidence interval [CI]: 2.29 to 4.78; p < 0.0001), ischemia at stress echocardiography (HR: 2.40, 95% CI: 1.65 to 3.48, p < 0.0001), left bundle branch block (HR: 2.26, 95% CI: 1.50 to 3.41; p < 0.0001), age (HR: 1.08, 95% CI: 1.06-1.10; p < 0.0001), resting wall motion score index (HR: 3.52, 95% CI: 2.38 to 5.21; p < 0.0001), male sex (HR: 1.74, 95% CI: 1.12 to 2.52; p = 0.003), and diabetes mellitus (HR: 1.47, 95% CI: 1.03 to 2.08; p = 0.03) were independent predictors of mortality.
Conclusions:
CFR on LAD is a strong and independent indicator of mortality, conferring additional prognostic value over wall motion analysis in patients with known or suspected CAD. A negative result on stress echocardiography with a normal CFR confers an annual risk of death <1% in both patient groups.
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