High resting coronary flow velocity (≥38 cm/s) independently predicted higher 10-year all-cause mortality compared to the lowest quintile (34% vs 15%; HR 1.311, 95% CI 1.040-1.652, p=0.02).
Cohort (n=10,023)
Yes
Does high resting coronary flow velocity predict all-cause death in patients with chronic coronary syndromes?
High resting coronary flow velocity in the mid-distal LAD assessed by TTE is an independent predictor of long-term all-cause mortality in patients with chronic coronary syndromes.
Effect estimate: HR 1.311 (95% CI 1.040-1.652)
Absolute Event Rate: 34% vs 15%
p-value: p=0.02
Abstract Background Coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery (LAD) can be easily assessed with transthoracic echocardiography (TTE). Although high resting CFV is associated with a reduced coronary flow velocity reserve which is a predictor of poor outcome, the prognostic significance of resting CFV remains unknown. Aim To assess the relationship between resting CFV and outcome. Methods Out of 11,410 initially screened, we prospectively enrolled 10,023 patients (age 64±12 years, 5,902 men, left ventricular ejection fraction LVEF 58±10%) with chronic coronary syndromes referred for resting TTE and with interpretable CFV. Recruitment (years 2004–2020) involved 5 accredited laboratories, with inter-observer variability 10% for CFV at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in mid-distal LAD. All-cause death was the only end-point. Results The feasibility of CFV was 95%. The mean CFV of LAD was 32±14 cm/s. By multivariable logistic regression analysis diabetes mellitus, prior myocardial infarction, lower LVEF and higher age, heart rate, and systolic blood pressure were associated with the highest quintile of CFV. During a mean follow-up of 4.6±3.7 years, 1,066 died. Mortality at 10-years was lowest (15%) in patients in the lowest quintile (≤24 cm/s) and highest (34%) in patients in the highest (≥38 cm/s) quintile of CFV. Age (HR 1.057, 95% CI 1.053–1.062; p0.0001), diabetes mellitus (HR 1.845, 95% CI 1.573–2.164; p0.0001), prior coronary surgery (HR 1.350, 95% CI 1.064–1.712; p=0.01), LVEF (HR 0.973, 95% CI 0.963–0.982; p0.0001), the 4th quintile (HR 1.267, 95% CI 1.010–1.589; p=0.04), and the 5th quintile of CFV of LAD (HR 1.311, 95% CI 1.040–1.652; p=0.02) independently predicted mortality. At incremental analysis, CFV of LAD added prognostic information to clinical findings and LVEF. Conclusion CFV imaging in mid-distal LAD is highly feasible with TTE. High resting CFV predicts worse survival in the long-term. Funding Acknowledgement Type of funding sources: None.
Ciampi et al. (Sat,) conducted a cohort in Chronic coronary syndromes (n=10,023). High resting coronary flow velocity (CFV) vs. Lowest quintile of CFV (≤24 cm/s) was evaluated on All-cause death (HR 1.311, 95% CI 1.040-1.652, p=0.02). High resting coronary flow velocity (≥38 cm/s) independently predicted higher 10-year all-cause mortality compared to the lowest quintile (34% vs 15%; HR 1.311, 95% CI 1.040-1.652, p=0.02).