BACKGROUND: Coronary flow velocity reserve (CFVR) and left ventricular contractile reserve (LVCR) have demonstrated prognostic importance in patients with diabetes. The aim of this study was to investigate the prognostic contribution of combined evaluation of CFVR and LVCR in patients with diabetes with nonischemic stress echocardiography. METHODS: Three hundred seventy-five patients with diabetes (mean age, 68 ± 9 years) with nonischemic dipyridamole stress echocardiography underwent assessment of CFVR of the left anterior descending coronary artery (prospectively) and LVCR with left ventricular force (retrospectively) in a multicenter study. RESULTS: On receiver operating characteristic analysis, LVCR ≤ 1.1 was the best prognostic predictor and was considered an abnormal value. CFVR was abnormal (≤2) in 139 patients (37%), LVCR in 156 (42%), neither in 157 (42%), and both in 77 (21%). During a median follow-up period of 16 months, 86 major adverse cardiac events occurred: 16 deaths, 13 myocardial infarctions, and 57 revascularizations. Multivariate prognostic indicators were CFVR ≤ 2 (P < .0001), age (P = .03), and LVCR ≤ 1.1 (P = .04). The 3-year rate of major adverse cardiac events was 63% in patients with both abnormal CFVR and LVCR, 42% in those with abnormal CFVR only, 19% in those with abnormal LVCR only, and 10% in patients with both normal CFVR and LVCR. The 3-year hard event rate was 3% in patients with both normal CFVR and LVCR, fivefold higher in patients with abnormal CFVR or LVCR only, and ninefold higher in patients with both abnormal CFVR and LVCR. CONCLUSIONS: Patients with diabetes with nonischemic dipyridamole stress echocardiography may still have significant risk in presence of abnormal CFVR and/or LVCR, which assess the underlying, largely unrelated, microvascular and myocardial components of coronary circulation.
BACKGROUND: Coronary flow velocity reserve (CFVR) and left ventricular contractile reserve (LVCR) have demonstrated prognostic importance in patients with diabetes. The aim of this study was to investigate the prognostic contribution of combined evaluation of CFVR and LVCR in patients with diabetes with nonischemic stress echocardiography. METHODS: Three hundred seventy-five patients with diabetes (mean age, 68 ± 9 years) with nonischemic dipyridamolestress echocardiography underwent assessment of CFVR of the left anterior descending coronary artery (prospectively) and LVCR with left ventricular force (retrospectively) in a multicenter study. RESULTS: On receiver operating characteristic analysis, LVCR ≤ 1.1 was the best prognostic predictor and was considered an abnormal value. CFVR was abnormal (≤2) in 139 patients (37%), LVCR in 156 (42%), neither in 157 (42%), and both in 77 (21%). During a median follow-up period of 16 months, 86 major adverse cardiac events occurred: 16 deaths, 13 myocardial infarctions, and 57 revascularizations. Multivariate prognostic indicators were CFVR ≤ 2 (P < .0001), age (P = .03), and LVCR ≤ 1.1 (P = .04). The 3-year rate of major adverse cardiac events was 63% in patients with both abnormal CFVR and LVCR, 42% in those with abnormal CFVR only, 19% in those with abnormal LVCR only, and 10% in patients with both normal CFVR and LVCR. The 3-year hard event rate was 3% in patients with both normal CFVR and LVCR, fivefold higher in patients with abnormal CFVR or LVCR only, and ninefold higher in patients with both abnormal CFVR and LVCR. CONCLUSIONS:Patients with diabetes with nonischemic dipyridamolestress echocardiography may still have significant risk in presence of abnormal CFVR and/or LVCR, which assess the underlying, largely unrelated, microvascular and myocardial components of coronary circulation.
Authors: Cuitlahuac Arroyo-Rodríguez; Juan Francisco Fritche-Salazar; Edith Liliana Posada-Martínez; Jose Antonio Arías-Godínez; Xochitl A Ortiz-León; Oscar Calvillo-Arguelles; María Eugenia Ruiz-Esparza; Juan Pablo Sandoval; Daniel Sierra-Lara; Diego Araiza-Garaygordobil; Eugenio Picano; Hugo Rodríguez-Zanella Journal: Int J Cardiovasc Imaging Date: 2020-01-01 Impact factor: 2.357
Authors: Marloes Sjoerdsma; Louis S Fixsen; Thijs Schoots; Frans N van de Vosse; Richard Gp Lopata Journal: Cardiovasc Ultrasound Date: 2020-05-29 Impact factor: 2.062
Authors: Hugo Rodriguez-Zanella; Rosina Arbucci; Juan Francisco Fritche-Salazar; Xochitl Arely Ortiz-Leon; Domenico Tuttolomondo; Diego Haber Lowenstein; Karina Wierzbowska-Drabik; Quirino Ciampi; Jarosław D Kasprzak; Nicola Gaibazzi; Jorge Lowenstein; Edith Liliana Posada-Martinez; Jose Antonio Arias-Godinez; Juan C de la Fuente-Mancera; Eugenio Picano Journal: J Clin Med Date: 2022-01-28 Impact factor: 4.241
Authors: Mihir A Kelshiker; Henry Seligman; James P Howard; Haseeb Rahman; Michael Foley; Alexandra N Nowbar; Christopher A Rajkumar; Matthew J Shun-Shin; Yousif Ahmad; Sayan Sen; Rasha Al-Lamee; Ricardo Petraco Journal: Eur Heart J Date: 2022-04-19 Impact factor: 35.855