Reduced coronary flow velocity reserve (≤2.0) during stress echocardiography was independently associated with adverse outcomes (HR 1.5; 95% CI 1.1-2.2; p=0.009).
Observational (n=3,410)
Yes
Does reduced coronary flow velocity reserve (CFVR) during stress echocardiography predict adverse outcomes in patients with known or suspected coronary artery disease and/or heart failure?
Assessment of coronary flow velocity reserve during stress echocardiography is highly feasible and provides independent prognostic value beyond regional wall motion abnormalities.
Effect estimate: HR 1.5 (95% CI 1.1 to 2.2)
p-value: p=0.009
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.
Ciampi et al. (2019) conducted an observational in Known or suspected coronary artery disease and/or heart failure (n=3,410). Coronary flow velocity reserve (CFVR) assessment vs. Normal CFVR (>2.0) was evaluated on Adverse outcome (HR 1.5, 95% CI 1.1 to 2.2, p=0.009). Reduced coronary flow velocity reserve (≤2.0) during stress echocardiography was independently associated with adverse outcomes (HR 1.5; 95% CI 1.1-2.2; p=0.009).