title: Prognostic value of transthoracic coronary flow reserve in medically treated patients with proximal left anterior descending artery stenosis of intermediate severity.
abstract: OBJECTIVE
  Prognostic value of transthoracic coronary flow reserve (T-CFR) is not established in patients with left anterior descending artery (LAD) stenosis of intermediate severity. Objective is to determine the prognosis value of T-CFR>2 in medically treated patients with angiographically intermediate [50-70% QCA (quantitative coronary angiography)] proximal LAD stenosis.
  
  
  RESULTS
  Among 110 consecutive patients with intermediate LAD stenosis who underwent prospectively T-CFR in the distal part of the LAD after intravenous administration of adenosine to assess the functional significance of the stenosis, 80 patients had T-CFR>2 and were treated medically without revascularization (Group 1). Among the 30 patients who had T-CFR<2, an additional dobutamine stress echocardiography (DSE) was performed: 15 had a negative DSE; were treated medically and served as a comparative group (Group 2), and 15 had a positive DSE; underwent LAD revascularization, and were excluded from further analysis. All patients completed follow-up (16+/-10 months). During the follow-up period (range 6-45 months), 76 patients (95%) remained free of death or LAD-related event in Group 1, vs. 12 patients (80%) in Group 2. By Kaplan-Meier method, at 30 months the per cent estimated survival free from death or target vessel-related events was 92+/-4% in Group 1 and 44+/-22% in Group 2 (P<0.01). By multivariate analysis, T-CFR remained the only independent predictor of death or LAD-related events.
  
  
  CONCLUSIONS
  In patients with proximal LAD stenosis of intermediate severity and T-CFR>2, deferral of revascularization is associated with low event rate.
authors.affiliation: Department of Cardiology and Intensive Care Unit, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200 Compiègne, France. patrickmeimoun@free.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Meimoun
authors.forename: Tahar
authors.initials: T
authors.lastname: Benali
authors.forename: Frederic
authors.initials: F
authors.lastname: Elmkies
authors.forename: Smain
authors.initials: S
authors.lastname: Sayah
authors.forename: Anne
authors.initials: A
authors.lastname: Luycx-Bore
authors.forename: Luc
authors.initials: L
authors.lastname: Doutrelan
authors.forename: Zemir
authors.initials: Z
authors.lastname: Hamdane
authors.forename: Jacques
authors.initials: J
authors.lastname: Boulanger
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology; D004452:Echocardiography / Q000379:methods; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis