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Prognostic value of Doppler echocardiographic coronary flow velocity assessment at rest in elderly patients
Angela Zagatina1,2, Elena Kalinina1,2, Martin Caprnda3
1Cardiology Department, Cardiocenter "Medika," St. Petersburg, Russian Federation.
Insights
Maximal coronary flow velocity (CFL) measured by Doppler ultrasound is a valuable tool for predicting mortality and myocardial infarction (MI) in elderly patients. Elevated CFL levels accurately identify individuals at higher risk for adverse cardiovascular events.
Area of Science:
- Cardiology
- Geriatrics
- Diagnostic Imaging
Background:
- Atherosclerosis and coronary artery disease (CAD) are leading causes of death in the elderly.
- Risk assessment in elderly patients is challenging due to various physical limitations.
- Non-invasive coronary artery velocity assessment by Doppler ultrasound may aid risk stratification in this population.
Purpose of the Study:
- To evaluate the prognostic value of coronary artery ultrasound assessment in a non-selected elderly population.
- To determine if Doppler-assessed coronary artery velocity can predict mortality and myocardial infarction (MI) in elderly individuals.
Main Methods:
- 145 patients aged ≥75 years underwent conventional echocardiography and left coronary artery flow scanning.
- Median follow-up was 26 months, during which mortality and non-fatal MI events were recorded.
Main Results:
- Maximal coronary velocity was the sole independent predictor of mortality (HR: 1.02) and mortality/MI (HR: 1.02).
- A maximal coronary flow velocity (CFL) of 110 cm/s best predicted death (specificity 90%), with an annual mortality rate of 16.6% for patients with CFL ≥110 cm/s.
- A CFL of 81 cm/s best predicted death/MI (specificity 80%), with an annual mortality rate of 11.2% for patients with CFL ≥81 cm/s.
Conclusions:
- Doppler CFL scanning during routine echocardiography is a feasible tool for assessing short-term prognosis in elderly patients.
- This non-invasive method provides valuable prognostic information for cardiovascular risk stratification in older adults.
Background:
Atherosclerosis and coronary artery disease (CAD) are a common condition and cause of death in the elderly population. There are difficulties with risk assessment in the elderly as the objectification of their symptomatic status can be challenging due to neuromuscular weakness, physical deconditioning or neurological, orthopaedic, peripheral vascular, or respiratory limitations. Non-invasive coronary artery velocity assessment by Doppler method at rest could be helpful in the elderly population. To evaluate the prognostic role of coronary artery ultrasound assessment in a non-selected elderly population in everyday clinical practice.
Methods:
One hundred forty-five patients, aged ≥75years (99 women; 80 ± 4 years), formed the study group. Left coronary artery flows were scanned in addition to conventional echocardiography. During a median follow-up of 26 months, 16 deaths and 2 non-fatal MI occurred.
Results:
In multivariable analysis, maximal coronary velocity was the only independent predictor for mortality (heart rate [HR]: 1.02, 95%, CI: 1.01-1.04, p < .0005) and for mortality/MI (HR: 1.02, 95%, CI: 1.01-1.03, p < .0001). The value of 110 cm/s maximal coronary flow velocity (CFL) in the proximal segments of left arteries was the best predictor for death, sensitivity 50%, specificity 90%, p < .005. The annual mortality rate was 16.6% persons/year for patients with elevated CFL ≥110 cm/s. The value 81 cm/s was the best predictor for death/MI, sensitivity 61%, specificity 80%, p < .0005; annual mortality rate was 11.2% persons/year for patients with elevated CFL ≥81 cm/s (p < .0001).
Conclusion:
Doppler CFL scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in elderly patients.
