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Coronary flow velocity reserve during dobutamine stress echocardiography
José Sebastião de Abreu1, José Wellington Oliveira Lima2, Tereza Cristina Pinheiro Diógenes1
1Prontocardio - Pronto Atendimento Cardiologico SC Ltda, Fortaleza, CE, Brasil.
Insights
Baseline diastolic peak velocity (DPV-Rest) is key for determining adequate coronary flow velocity reserve (CFVR). Discontinuing beta-blockers before dobutamine stress echocardiography increases the likelihood of an inadequate CFVR, impacting coronary artery disease assessment.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Echocardiography
Background:
- Coronary flow velocity reserve (CFVR) ≥2 indicates favorable prognosis or absence of significant coronary artery disease.
- Dobutamine stress echocardiography (DSE) is used to assess myocardial ischemia.
Purpose of the Study:
- Identify parameters for obtaining adequate or inadequate CFVR in the left anterior descending (LAD) coronary artery during DSE.
- Evaluate the impact of beta-blocker discontinuation on CFVR.
Main Methods:
- 100 patients undergoing DSE for myocardial ischemia detection were studied.
- CFVR calculated as ratio of diastolic peak velocity (DPV) during DSE to DPV at rest.
- Patients discontinued beta-blockers 72 hours prior to the test.
Main Results:
- Older patients and those with lower ejection fraction had inadequate CFVR.
- Higher baseline DPV (DPV-Rest) was associated with inadequate CFVR (p<0.0001).
- Beta-blocker discontinuation was linked to a 4-fold increased chance of inadequate CFVR (p=0.027).
Conclusions:
- DPV-Rest is the primary parameter for determining adequate CFVR.
- Beta-blocker discontinuation significantly correlates with inadequate CFVR.
- DSE for LAD assessment is feasible and time-efficient.
Background:
A coronary flow velocity reserve (CFVR)≥2 is adequate to infer a favorable prognosis or the absence of significant coronary artery disease.
Objective:
To identify parameters which are relevant to obtain CFVR (adequate or inadequate) in the left anterior descending coronary artery (LAD) during dobutamine stress echocardiography (DSE).
Methods:
100 patients referred for detection of myocardial ischemia by DSE were evaluated; they were instructed to discontinue the use of β-blockers 72 hours prior to the test. CFVR was calculated as a ratio of the diastolic peak velocity (cm/s) (DPV) on DSE (DPV-DSE) to baseline DPV at rest (DPV-Rest). In group I, CFVR was <2 and, in group II, CFVR was ≥2. The Fisher's exact test and Student's t test were used for the statistical analyses. P values<0.05 were considered statistically significant.
Results:
At rest, the time (in seconds) to obtain Doppler in LAD in groups I and II was not different (53±31 vs. 45±32; p=0.23). During DSE, LAD was recorded in 92 patients. Group I patients were older (65.9±9.3 vs. 61.2±10.8 years; p=0.04), had lower ejection fraction (61±10 vs. 66±6%; p=0.005), higher DPV-Rest (36.81±08 vs. 25.63±06 cm/s; p<0.0001) and lower CFVR (1.67±0.24 vs. 2.53±0.57; p<0.0001), but no difference was observed regarding DPVDSE (61.40±16 vs. 64.23±16 cm/s; p=0.42). β-blocker discontinuation was associated with a 4-fold higher chance of a CFVR<2 (OR= 4; 95% CI [1.171-13.63], p=0.027).
Conclusion:
DPV-Rest was the main parameter to determine an adequate CFVR. β-blocker discontinuation was significantly associated with inadequate CFVR. The high feasibility and the time to record the LAD corroborate the use of this methodology.
