[Long-term prognostic value of coronary flow reserve in patients without significant left anterior descending coronary artery stenosis: results from the SZEGED Study].
Coronary flow reserve (CFR) measured by pulsed Doppler echocardiography is a useful hemodynamic index to evaluate coronary microcirculatory (dys)function in the left anterior descending coronary artery (LAD), in the absence of macrovascular lesions.


OBJECTIVE
The present study was designed to evaluate long-term prognostic value of CFR in patients without significant epicardial LAD stenosis.


METHODS
A total of 166 patients without significant LAD stenosis were enrolled in this prospective follow-up study. Coronary angiography demonstrated absence of significant LAD disease in all cases. All patients underwent transthoracic and stress transesophageal echocardiography (CFR measurement) and coronary angiography.


RESULTS
The success rate of follow-up was 124 out of 166 (75%). During a mean follow-up of 93+/-34 months 27 patients died, including 16 sudden cardiac deaths, 3 acute heart failures, 2 strokes, while 6 patients had pulmonary or gastrointestinal malignancies. Using ROC analysis, the best cut-off value for CFR was 2.13 to predict survival (sensitivity 67%, specificity 60%, area, under the curve 62%, p = 0.046). Patients with CFR < 2.13 had significantly more events (32% vs. 13%, p<0.05). The logistic regression model identified CFR (hazard ratio (HR) 2.43, p = 0.04) and left ventricular end-systolic volume (HR 1.09, p = 0.03) as independent predictors of survival.


CONCLUSIONS
Long-term prognostic significance of CFR for prediction of survival has been demonstrated during a long-term follow-up in patients without significant LAD stenosis.
Szegedi Tudományegyetem, Altalános Orvostudományi Kar, II. Belgyógyászati Klinika és Kardiológiai Központ, Szeged.
Erika
E
Balázs
Kinga Szilvia
KS
Pintér
Agnes
A
Egyed
Miklós
M
Csanády
Tamás
T
Forster
Attila
A
Nemes
D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000503:physiopathology*; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006331:Heart Diseases / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D014654:Vascular Patency