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Prognostic Value of Transthoracic Doppler Echocardiography Coronary Flow Velocity Reserve in Patients With Asymmetric
Milorad Tesic1,2, Branko Beleslin1,2, Vojislav Giga1,2
1Clinic for CardiologyClinical Center of Serbia Belgrade Serbia.
Insights
Impaired coronary flow velocity reserve in the left anterior descending artery (CFVR LAD) is a strong predictor of adverse cardiac events in hypertrophic cardiomyopathy (HCM) patients. This finding aids in HCM risk stratification, making posterior descending artery (PD) assessment redundant.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Microvascular dysfunction is implicated in hypertrophic cardiomyopathy (HCM) progression.
- The long-term prognostic significance of transthoracic Doppler echocardiography (TDE) derived coronary flow velocity reserve (CFVR) in HCM remains unclear.
Purpose of the Study:
- To evaluate the long-term prognostic value of CFVR on clinical outcomes in patients with HCM.
- To determine if CFVR assessment can aid in risk stratification for HCM patients.
Main Methods:
- Prospective study of 150 HCM patients, assessing clinical, echocardiographic, and CFVR (LAD and PD) parameters.
- Patients stratified by CFVR LAD values (Group 1: >2, Group 2: ≤2).
- Primary outcome: composite of HCM-related death, heart failure hospitalization, sustained ventricular tachycardia, and ischemic stroke, with median follow-up of 88 months.
Main Results:
- 41.3% of patients experienced adverse cardiac events during follow-up.
- Group 2 (impaired CFVR LAD ≤2) had significantly higher adverse events (52.4%) compared to Group 1 (9.2%, P<0.001).
- Impaired CFVR LAD (≤2) was identified as an independent predictor of adverse outcomes (HR 6.54, P<0.001), while CFVR PD was not significant.
Conclusions:
- Reduced CFVR in the LAD artery is a robust, independent predictor of adverse clinical outcomes in HCM.
- CFVR LAD assessment is crucial for risk stratification in HCM, rendering CFVR PD evaluation unnecessary when LAD data is available.
Abstract:
Background Microvascular dysfunction might be a major determinant of clinical deterioration and outcome in patients with hypertrophic cardiomyopathy (HCM). However, long-term prognostic value of transthoracic Doppler echocardiography (TDE) coronary flow velocity reserve (CFVR) on clinical outcome is uncertain in HCM patients. Therefore, the aim of our study was to assess long-term prognostic value of CFVR on clinical outcome in HCM population. Methods and Results We prospectively included 150 HCM patients (82 women; mean age 48±15 years). Patients' clinical characteristics, echocardiographic and CFVR findings (both for left anterior descending [LAD] and posterior descending artery [PD]), were assessed in all patients. The primary outcome was a composite of: HCM related death, heart failure requiring hospitalization, sustained ventricular tachycardia and ischemic stroke. Patients were stratified into 2 subgroups depending on CFVR LAD value: Group 1 (CFVR LAD>2, [n=87]) and Group 2 (CFVR LAD≤2, [n=63]). During a median follow-up of 88 months, 41/150 (27.3%) patients had adverse cardiac events. In Group 1, there were 8/87 (9.2%), whereas in Group 2 there were 33/63 (52.4%, P<0.001 vs. Group 1) adverse cardiac events. By Kaplan-Meier analysis, patients with preserved CFVR LAD had significantly higher cumulative event-free survival rate compared to patients with impaired CFVR LAD (96.4% and 90.9% versus 66.9% and 40.0%, at 5 and 8 years, respectively: log-rank 37.2, P<0.001). Multivariable analysis identified only CFVR LAD≤2 as an independent predictor for adverse cardiac outcome (HR 6.54; 95% CI 2.83-16.30, P<0.001), while CFVR PD was not significantly associated with outcome. Conclusions In patients with HCM, impaired CFVR LAD (≤2) is a strong, independent predictor of adverse cardiac outcome. When the aim of testing is HCM risk stratification and CFVR LAD data are available, the evaluation of CFVR PD is redundant.
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