TY - JOUR

T1 - Functional, Anatomical, and Prognostic Correlates of Coronary Flow Velocity Reserve During Stress Echocardiography

AU - Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography

AU - Ciampi, Quirino

AU - Zagatina, Angela

AU - Cortigiani, Lauro

AU - Gaibazzi, Nicola

AU - Borguezan Daros, Clarissa

AU - Zhuravskaya, Nadezhda

AU - Wierzbowska-Drabik, Karina

AU - Kasprzak, Jaroslaw D.

AU - de Castro e Silva Pretto, José Luis

AU - D'Andrea, Antonello

AU - Djordjevic-Dikic, Ana

AU - Monte, Ines

AU - Simova, Iana

AU - Boshchenko, Alla

AU - Citro, Rodolfo

AU - Amor, Miguel

AU - Merlo, Pablo Martin

AU - Dodi, Claudio

AU - Rigo, Fausto

AU - Gligorova, Suzana

AU - Dekleva, Milica

AU - Severino, Sergio

AU - Lattanzi, Fabio

AU - Scali, Maria Chiara

AU - Vrublevsky, Alexander

AU - Torres, Marco A.R.

AU - Salustri, Alessandro

AU - Rodrìguez-Zanella, Hugo

AU - Costantino, Fabio Marco

AU - Varga, Albert

AU - Bossone, Eduardo

AU - Colonna, Paolo

AU - De Nes, Michele

AU - Paterni, Marco

AU - Carpeggiani, Clara

AU - Lowenstein, Jorge

AU - Gregori, Dario

AU - Picano, Eugenio

PY - 2019/11/5

Y1 - 2019/11/5

N2 - Background: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). Objectives: The purpose of this study was to assess the feasibility and functional correlates of CFVR. Methods: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. Results: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. Conclusions: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.

AB - Background: The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA). Objectives: The purpose of this study was to assess the feasibility and functional correlates of CFVR. Methods: This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up. Results: The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome. Conclusions: CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.

KW - coronary artery disease

KW - coronary flow velocity reserve

KW - heart failure

KW - lung ultrasound

KW - stress echocardiography

KW - REGIONAL WALL-MOTION

KW - FEASIBILITY

KW - RECOMMENDATIONS

KW - TRANSTHORACIC DOPPLER

KW - ARTERY

KW - EUROPEAN ASSOCIATION

KW - AMERICAN SOCIETY

UR - http://www.scopus.com/inward/record.url?scp=85073561087&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/functional-anatomical-prognostic-correlates-coronary-flow-velocity-reserve-during-stress-echocardiog

U2 - 10.1016/j.jacc.2019.08.1046

DO - 10.1016/j.jacc.2019.08.1046

M3 - Article

AN - SCOPUS:85073561087

VL - 74

SP - 2278

EP - 2291

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 18

ER -