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Reduction of Coronary Flow Velocity Reserve as the Main Driver of Prognostically Beneficial Coronary

Lauro Cortigiani1, Nicola Gaibazzi2, Quirino Ciampi3

  • 1Cardiology Division, San Luca Hospital, Lucca, Italy.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|October 10, 2024
PubMed

Insights

Coronary revascularization guided by coronary flow velocity reserve (CFVR) improves survival in patients with chronic coronary syndromes (CCS) and significant left anterior descending (LAD) artery disease, regardless of wall motion abnormalities. This physiology-driven approach offers a prognostic benefit.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Regional wall motion abnormality (RWMA) may be absent in stress echocardiography (SE) for patients with chronic coronary syndromes (CCS) and significant coronary artery disease (CAD), despite reduced coronary flow velocity reserve (CFVR).
  • This highlights a potential gap in diagnosing significant coronary artery disease (CAD) using traditional stress echocardiography (SE) alone.

Purpose of the Study:

  • To evaluate the effectiveness of a physiology-driven strategy for coronary revascularization in patients with significant left anterior descending (LAD) artery disease.
  • The approach is based on coronary flow velocity reserve (CFVR) measurements.

Main Methods:

  • A 3-center observational study retrospectively analyzed prospectively acquired data from 749 patients with CCS, reduced LAD CFVR (≤2.0), and ≥50% LAD stenosis.
  • Patients underwent dipyridamole stress echocardiography (SE).
  • Follow-up for all-cause death was conducted over 6.4 ± 4.5 years.

Main Results:

  • Inducible RWMA was observed in 39% of patients; CFVR was lower in those with RWMA.
  • Coronary revascularization was performed in 69% of patients.
  • The 10-year survival was significantly higher for invasively treated patients (76%) compared to conservatively treated patients (53%). This benefit persisted regardless of inducible RWMA or isolated CFVR reduction.
  • A physiology-driven strategy (based on CFVR) for revascularization showed a significant prognostic benefit.

Conclusions:

  • Coronary revascularization guided by reduced CFVR in patients with CCS and significant LAD disease provides a prognostic benefit.
  • This benefit is independent of the presence of inducible RWMA on stress echocardiography.
  • A physiology-driven approach using CFVR is valuable for managing significant LAD disease.
Abstract

Keywords:
Coronary flow velocity reserveCoronary revascularizationDipyridamoleLeft anterior descending arteryPrognosis

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