OBJECTIVES: The aim of this prospective, multicenter, observational study was to compare the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) in diabetic and nondiabetic patients with known or suspected coronary artery disease and negative dipyridamole stress echocardiography. BACKGROUND: The prognostic value of CFR in diabetic patients with negative stress echocardiography remains unknown. METHODS: The study group consisted of 1,130 patients (207 diabetics) with known (n = 418) or suspected (n = 712) coronary artery disease and negative stress echocardiography by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 min) echocardiography with CFR evaluation of left anterior descending artery by Doppler. A value of CFR < or =2.0 was considered abnormal. RESULTS: Coronary flow reserve was abnormal in 309 (27%) patients. During a median follow-up of 16 months, 98 events (8 deaths, 24 ST-segment elevation myocardial infarctions, and 66 non-ST-segment elevation myocardial infarctions) occurred. In addition, 101 patients underwent revascularization and were censored. Multivariable prognostic indicators were abnormal CFR (p < 0.0001), anti-ischemic therapy at the time of testing (p = 0.002), age (p = 0.02), and resting wall motion abnormality (p = 0.05). The event rate was markedly higher (p < 0.0001) for both diabetic and nondiabetic patients with abnormal CFR as compared with diabetic and nondiabetic patients with normal CFR. Of note, a preserved CFR off therapy identified diabetic and nondiabetic patients with better survival and comparable yearly event rates (2.2% vs. 2.0%, p = 0.80). CONCLUSIONS: Coronary flow reserve provides independent prognostic information in diabetic and nondiabetic patients with known or suspected coronary artery disease and negative dipyridamole stress echocardiography. In particular, a normal CFR off therapy is associated with better and similar survival in the 2 populations.
OBJECTIVES: The aim of this prospective, multicenter, observational study was to compare the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) in diabetic and nondiabeticpatients with known or suspected coronary artery disease and negative dipyridamole stress echocardiography. BACKGROUND: The prognostic value of CFR in diabeticpatients with negative stress echocardiography remains unknown. METHODS: The study group consisted of 1,130 patients (207 diabetics) with known (n = 418) or suspected (n = 712) coronary artery disease and negative stress echocardiography by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 min) echocardiography with CFR evaluation of left anterior descending artery by Doppler. A value of CFR < or =2.0 was considered abnormal. RESULTS: Coronary flow reserve was abnormal in 309 (27%) patients. During a median follow-up of 16 months, 98 events (8 deaths, 24 ST-segment elevation myocardial infarctions, and 66 non-ST-segment elevation myocardial infarctions) occurred. In addition, 101 patients underwent revascularization and were censored. Multivariable prognostic indicators were abnormal CFR (p < 0.0001), anti-ischemic therapy at the time of testing (p = 0.002), age (p = 0.02), and resting wall motion abnormality (p = 0.05). The event rate was markedly higher (p < 0.0001) for both diabetic and nondiabeticpatients with abnormal CFR as compared with diabetic and nondiabeticpatients with normal CFR. Of note, a preserved CFR off therapy identified diabetic and nondiabeticpatients with better survival and comparable yearly event rates (2.2% vs. 2.0%, p = 0.80). CONCLUSIONS: Coronary flow reserve provides independent prognostic information in diabetic and nondiabeticpatients with known or suspected coronary artery disease and negative dipyridamole stress echocardiography. In particular, a normal CFR off therapy is associated with better and similar survival in the 2 populations.
Authors: G de Simone; R B Devereux; M J Roman; M Chinali; A Barac; J A Panza; E T Lee; J M Galloway; B V Howard Journal: Nutr Metab Cardiovasc Dis Date: 2011-09-21 Impact factor: 4.222
Authors: Attila Nemes; Erika Balázs; Osama I I Soliman; Róbert Sepp; Miklós Csanády; Tamás Forster Journal: Heart Vessels Date: 2009-09-27 Impact factor: 2.037
Authors: Ville Varho; Tuomas O Kiviniemi; Wail Nammas; Jussi Sia; Hannu Romppanen; Mikko Pietilä; Juhani K Airaksinen; Jussi Mikkelsson; Petri Tuomainen; Anssi Perälä; Pasi P Karjalainen Journal: Int J Cardiovasc Imaging Date: 2016-04-13 Impact factor: 2.357