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Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with
José Sebastião de Abreu1,2,3, Eduardo Arrais Rocha1,2,3, Isadora Sucupira Machado2
1Clínica Clinicárdio, de Fortaleza, CE - Brazil.
Insights
Normal coronary flow velocity reserve (CFVR) obtained before reaching target heart rate (HR) in patients with preserved ejection fraction is linked to a better prognosis. This finding highlights the importance of CFVR timing during dobutamine stress echocardiography for risk stratification.
Area of Science:
- Cardiology
- Echocardiography
- Diagnostic Imaging
Background:
- Normal coronary flow velocity reserve (CFVR) (≥ 2) in the left anterior descending coronary artery (LAD) via transthoracic echocardiography indicates a good prognosis.
- However, studies correlating CFVR with submaximal target heart rate (HR) are lacking.
Purpose of the Study:
- To assess the prognostic significance of LAD CFVR in patients with preserved left ventricular ejection fraction (>50%) who underwent dobutamine stress echocardiography (DSE).
- The study specifically considered the role of achieving target HR during the DSE procedure.
Main Methods:
- A prospective study included patients with preserved LVEF and LAD CFVR who completed DSE.
- Group I (n=31) had normal CFVR before target HR, Group II (n=28) had normal CFVR after target HR, and Group III (n=24) had abnormal CFVR despite reaching target HR.
- Events included death, acute coronary insufficiency, coronary intervention, angiography without intervention, and hospitalization.
Main Results:
- Over 28±4 months, 21.6% of patients experienced events.
- Event rates were significantly lower in Group I (6%) and Group II (18%) compared to Group III (46%).
- Regression analysis showed Group III had more events than GI (p<0.001) and GII (p<0.045), with no significant difference between GI and GII (p=0.160). Adjusted analysis maintained the difference between GIII and GI (p=0.012).
Conclusions:
- In patients with preserved LVEF who completed DSE, normal CFVR achieved before reaching the target HR is associated with a superior prognosis.
- This suggests the timing of normal CFVR acquisition relative to target HR is a crucial prognostic indicator.
Background::
Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR).
Objective::
To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR.
Methods::
Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events.
Results::
In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012).
Conclusion::
In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis.
Fundamento::
A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima).
Objetivo::
Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina (EED) concluído, considerando a FC alvo submáxima.
MéTodos::
studo prospectivo de pacientes com FEVE preservada e RVFC obtida na ADA durante EED concluído. No Grupo I (GI=31), a RVFC adequada foi obtida antes de se atingir a FC alvo, e no Grupo II (G II=28), após. O Grupo III (G III=24) atingiu a FC alvo, mas a RVFC foi inadequada. Foram considerados eventos: óbito, insuficiência coronariana aguda, intervenção coronariana, coronariografia sem intervenção subsequente e internamento hospitalar.
Resultados::
Em 28 ± 4 meses, ocorreram 18 (21,6%) eventos, sendo 6% (2/31) no GI, 18% (5/28) no GII e 46% (11/24) no GIII. Foram 4 (4,8%) óbitos, 6 (7,2%) intervenções coronarianas e 8 (9,6%) coronariografias sem intervenção subsequente. Na sobrevida livre de eventos pela análise de regressão, GIII apresentou mais eventos do que GI (p < 0,001) ou GII (p < 0,045), não havendo diferença entre GI e GII (p = 0,160). Após o ajustamento, foi mantida a diferença apenas entre GIII e GI (p = 0,012).
ConclusãO::
Em pacientes com FEVE preservada e EED concluído, a RVFC adequada obtida antes da FC alvo associou-se ao melhor prognóstico.
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