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High Resting Coronary Flow Velocity by Echocardiography Is Associated With Worse Survival in Patients With Chronic
Lauro Cortigiani1, Nicola Gaibazzi2, Quirino Ciampi3
1Cardiology Division, San Luca Hospital Lucca Italy.
Insights
High resting coronary flow velocity (CFV) is linked to poorer survival in chronic coronary syndromes. This finding, along with reduced CFV reserve (CFVR), independently predicts mortality, with the combination indicating the worst outcomes.
Area of Science:
- Cardiology
- Echocardiography
- Coronary Artery Disease
Background:
- Resting coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery is easily assessed via transthoracic echocardiography.
- Chronic coronary syndromes (CCS) represent a significant clinical challenge.
- Assessing CFV and CFV reserve (CFVR) may offer prognostic insights in CCS patients.
Purpose of the Study:
- To evaluate the association between resting CFV, CFVR, and clinical outcomes in patients with CCS.
- To determine if resting CFV and CFVR are independent predictors of mortality.
- To investigate the combined prognostic value of resting CFV and CFVR.
Main Methods:
- A prospective multicenter study retrospectively analyzed 7576 patients with CCS and preserved left ventricular ejection fraction (LVEF ≥50%).
- Resting peak diastolic CFV was measured using pulsed-wave Doppler in the mid-distal LAD.
- Dipyridamole stress echocardiography was used to assess CFVR, with an abnormal value defined as ≤2.0. All-cause death was the primary endpoint.
Main Results:
- The mean resting CFV was 31±12 cm/s, and the mean CFVR was 2.32±0.60.
- During a median follow-up of 5.9 years, 15% of patients died.
- Multivariable analysis identified resting CFV ≥32 cm/s (HR, 1.24) and CFVR ≤2.0 (HR, 1.78) as independent predictors of mortality, alongside age, diabetes, prior coronary surgery, and LVEF.
Conclusions:
- Elevated resting CFV is independently associated with worse survival in patients with CCS and preserved LVEF.
- The prognostic value of resting CFV is additive to that of CFVR.
- The combination of high resting CFV and low CFVR identifies patients with the highest mortality risk.
Background:
Resting coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery can be easily assessed with transthoracic echocardiography. In this observational study, the authors sought to assess the relationship between resting CFV, CFV reserve (CFVR), and outcome in patients with chronic coronary syndromes.
Methods And Results:
In a prospective multicenter study design, the authors retrospectively analyzed 7576 patients (age, 66±11 years; 4312 men) with chronic coronary syndromes and left ventricular ejection fraction ≥50% referred for dipyridamole stress echocardiography. Recruitment (years 2003-2021) involved 7 accredited laboratories, with interobserver variability <10% for CFV measurement at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in the mid-distal left anterior descending coronary artery. CFVR (abnormal value ≤2.0) was assessed with dipyridamole. All-cause death was the only end point. The mean CFV of the left anterior descending coronary artery was 31±12 cm/s. The mean CFVR was 2.32±0.60. During a median follow-up of 5.9±4.3 years, 1121 (15%) patients died. At multivariable analysis, resting CFV ≥32 cm/s was identified by a receiver operating curve as the best cutoff and was independently associated with mortality (hazard ratio [HR], 1.24 [95% CI, 1.10-1.40]; P<0.0001) together with CFVR ≤2.0 (HR, 1.78 [95% CI, 1.57-2.02]; P<0.0001), age, diabetes, history of coronary surgery, and left ventricular ejection fraction. When both CFV and CFVR were considered, the mortality rate was highest in patients with resting CFV ≥32 cm/s and CFVR ≤2.0 and lowest in patients with resting CFV <32 cm/s and CFVR >2.0.
Conclusions:
High resting CFV is associated with worse survival in patients with chronic coronary syndromes and left ventricular ejection fraction ≥50%. The value is independent and additive to CFVR. The combination of high resting CFV and low CFVR is associated with the worst survival.
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