title: Prognostic value of coronary flow reserve in medically treated patients with left anterior descending coronary disease with stenosis 51% to 75% in diameter.
abstract: According to American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions 2005 guidelines on percutaneous intervention, intracoronary physiologic measurement in the assessment of effects of intermediate coronary stenoses in patients with anginal symptoms is a class IIa indication. This study assessed the additional prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in patients with single-vessel disease and intermediate stenosis severity. We enrolled 86 patients (44 men; 66 +/- 10 years of age) with angiographically assessed single-vessel coronary artery disease of the left anterior descending coronary artery (LAD) with quantitatively assessed diameter stenosis severity 50% to 75%. All patients underwent dipyridamole (up to 0.84 mg/kg over 6 minutes) stress echocardiography with wall motion analysis by 2-dimensional echocardiography and CFR evaluation of the affected artery by Doppler. All patients were followed up for a median of 14 months (first quartile 10, third quartile 18) after diagnostic coronary angiography (without percutaneous intervention for a clinically driven decision). Mean diameter stenosis of the LAD was 58 +/- 10%. Mean CFR of the LAD was 2.09 +/- 0.5. Regional wall motion abnormality at peak stress was present in 17 patients. During follow-up, 24 events occurred: 6 nonfatal ST-elevation myocardial infarctions and 18 non-ST-elevation myocardial infarctions. Thirty-month spontaneous event-free survival was higher in patients with normal CFR and lower in patients with decreased CFR (86% vs 30%, p = 0.0001). At Cox analysis, a CFR <2 (hazard ratio 24.2, 95% confidence interval 3.2 to 179.7, p = 0.002) was the only independent prognostic predictor of outcome. In conclusion, in medically treated patients with single-vessel disease of intermediate severity, decreased CFR is associated with a worse outcome.
authors.affiliation: Cardiology Division, Umberto Io Hospital, Mestre-Venice, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Sonia
authors.initials: S
authors.lastname: Gherardi
authors.forename: Ana
authors.initials: A
authors.lastname: Djordjevic-Dikic
authors.forename: Lauro
authors.initials: L
authors.lastname: Cortigiani
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004176:Dipyridamole; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology; D009566:Nitrates / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D014665:Vasodilator Agents
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D009566:Nitrates; D014665:Vasodilator Agents; D004176:Dipyridamole