Quirino Ciampi1, Angela Zagatina2, Lauro Cortigiani3, Nicola Gaibazzi4, Clarissa Borguezan Daros5, Nadezhda Zhuravskaya2, Karina Wierzbowska-Drabik6, Jaroslaw D Kasprzak6, José Luis de Castro E Silva Pretto7, Antonello D'Andrea8, Ana Djordjevic-Dikic9, Ines Monte10, Iana Simova11, Alla Boshchenko12, Rodolfo Citro13, Miguel Amor14, Pablo Martin Merlo15, Claudio Dodi16, Fausto Rigo17, Suzana Gligorova18, Milica Dekleva19, Sergio Severino20, Fabio Lattanzi21, Maria Chiara Scali21, Alexander Vrublevsky12, Marco A R Torres22, Alessandro Salustri23, Hugo Rodrìguez-Zanella24, Fabio Marco Costantino25, Albert Varga26, Eduardo Bossone27, Paolo Colonna28, Michele De Nes29, Marco Paterni29, Clara Carpeggiani29, Jorge Lowenstein15, Dario Gregori30, Eugenio Picano31. 1. Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy. 2. Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg, Russian Federation. 3. Cardiology Department, San Luca Hospital, Lucca, Italy. 4. Cardiology Department, Parma University Hospital, Parma, Italy. 5. Cardiology Division, Hospital São José, Criciuma, Brazil. 6. Cardiology, Bieganski Hospital, Medical University, Lodz, Poland. 7. Hospital Sao Vicente de Paulo e Hospital de Cidade, Passo Fundo, Brazil. 8. Cardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy. 9. Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia. 10. Cardio-Thorax-Vascular Department, Echocardiography Lab, "Policlinico Vittorio Emanuele," Catania University, Catania, Italy. 11. Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria. 12. Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation. 13. Cardiology Department and Echocardiography Lab, University Hospital "San Giovanni di Dio e Ruggi d'Aragona," Salerno, Italy. 14. Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina. 15. Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina. 16. Casa di Cura Figlie di San Camillo, Cremona, Italy. 17. Cardiology Department, Ospedale dell'Angelo Mestre-Venice, Venice, Italy. 18. Cardiology Division Ospedale Casilino, Roma, Italy. 19. Clinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade, Serbia. 20. Cardiology Department, Coronary Care Unit, Monaldi Hospital, Second University of Naples, Naples, Italy. 21. Cardiothoracic Department, University of Pisa, Pisa, Italy. 22. Hospital de Clinicas de Porto Alegre-Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 23. Non-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar. 24. Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico. 25. Cardiology Department, San Carlo Hospital, Potenza, Italy. 26. Institute of Family Medicine, University of Szeged, Szeged, Hungary. 27. Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy. 28. Cardiology Hospital, Policlinico of Bari, Bari, Italy. 29. CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy. 30. Biostatistics, Epidemiology and Public Health Unit, Padova University, Padova, Italy. 31. CNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy. Electronic address: picano@ifc.cnr.it.
Abstract
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.
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.
Authors: Eugenio Picano; Quirino Ciampi; Lauro Cortigiani; Adelaide M Arruda-Olson; Clarissa Borguezan-Daros; José Luis de Castro E Silva Pretto; Rosangela Cocchia; Eduardo Bossone; Elisa Merli; Garvan C Kane; Albert Varga; Gergely Agoston; Maria Chiara Scali; Doralisa Morrone; Iana Simova; Martina Samardjieva; Alla Boshchenko; Tamara Ryabova; Alexander Vrublevsky; Attila Palinkas; Eszter D Palinkas; Robert Sepp; Marco A R Torres; Hector R Villarraga; Tamara Kovačević Preradović; Rodolfo Citro; Miguel Amor; Hugo Mosto; Michael Salamè; Paul Leeson; Cristina Mangia; Nicola Gaibazzi; Domenico Tuttolomondo; Costantina Prota; Jesus Peteiro; Caroline M Van De Heyning; Antonello D'Andrea; Fausto Rigo; Aleksandra Nikolic; Miodrag Ostojic; Jorge Lowenstein; Rosina Arbucci; Diego M Lowenstein Haber; Pablo M Merlo; Karina Wierzbowska-Drabik; Jaroslaw D Kasprzak; Maciej Haberka; Ana Cristina Camarozano; Nithima Ratanasit; Fabio Mori; Maria Grazia D'Alfonso; Luigi Tassetti; Alessandra Milazzo; Iacopo Olivotto; Alberto Marchi; Hugo Rodriguez-Zanella; Angela Zagatina; Ratnasari Padang; Milica Dekleva; Ana Djordievic-Dikic; Nikola Boskovic; Milorad Tesic; Vojislav Giga; Branko Beleslin; Giovanni Di Salvo; Valentina Lorenzoni; Matteo Cameli; Giulia Elena Mandoli; Tonino Bombardini; Pio Caso; Jelena Celutkiene; Andrea Barbieri; Giovanni Benfari; Ylenia Bartolacelli; Alessandro Malagoli; Francesca Bursi; Francesca Mantovani; Bruno Villari; Antonello Russo; Michele De Nes; Clara Carpeggiani; Ines Monte; Federica Re; Carlos Cotrim; Giuseppe Bilardo; Ariel K Saad; Arnas Karuzas; Dovydas Matuliauskas; Paolo Colonna; Francesco Antonini-Canterin; Mauro Pepi; Patricia A Pellikka Journal: J Clin Med Date: 2021-08-17 Impact factor: 4.964
Authors: Francesco Tona; Elena Osto; Peter L M Kerkhof; Roberta Montisci; Giulia Famoso; Giulia Lorenzoni; Laura De Michieli; Annagrazia Cecere; Irene Zanetti; Giovanni Civieri; Sabino Iliceto; Stefano Piaserico Journal: Eur J Clin Invest Date: 2021-11-25 Impact factor: 5.722
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Authors: Lauro Cortigiani; Clara Carpeggiani; Laura Meola; Ana Djordjevic-Dikic; Francesco Bovenzi; Eugenio Picano Journal: J Clin Med Date: 2021-12-23 Impact factor: 4.241