title: Long-term prognostic significance of coronary flow velocity reserve in patients with significant coronary artery disease not involving the left anterior descending coronary artery (results from the SZEGED study).
abstract: OBJECTIVE
  Coronary flow velocity reserve (CFR) by pulsed Doppler echocardiography is a useful hemodynamic index to evaluate the coronary microcirculatory dysfunction in the left anterior descending coronary artery (LAD). The present study was designed to evaluate the long-term predictive value of CFR for mortality in patients with right (RC) and/or left circumflex coronary artery (CX) stenosis without epicardial LAD disease.
  
  
  METHODS
  A total of 49 patients with significant RC and/or CX stenosis were enrolled in this prospective follow-up study. All patients had undergone coronary angiography demonstrating significant RC and/or CX stenosis without LAD disease and dipyridamole stress transoesophageal echocardiography as CFR measurement.
  
  
  RESULTS
  The success rate of follow-up was 43 out of 49 (88%). During a mean follow-up of 97 +/- 29 months, 14 patients suffered cardiovascular deaths (12 sudden cardiac deaths and 2 strokes), and 1 patient died of pulmonal tumor. Patients who died during the follow-up had significantly lower CFR values (1.85 +/- 0.43 vs. 2.31 +/- 0.57, P < 0.05). Using ROC analysis, CFR <2.09 had the highest accuracy in predicting cardiovascular survival (sensitivity 80%, specificity 57%, area under the curve 73%, P = 0.003). The logistic regression model identified only CFR as an independent predictor of survival (hazard ratio [HR] 6.26, 95% CI of HR 1.23-19.61, P = 0.024).
  
  
  CONCLUSIONS
  Long-term prognostic significance of CFR for the prediction of mortality has been demonstrated during a 9-year follow-up in patients with significant coronary artery disease not involving the LAD.
authors.affiliation: Second Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Clinical Center, University of Szeged, H-6720 Szeged, Hungary. nemes@in2nd.szote.u-szeged.hu
authors.forename: Attila
authors.initials: A
authors.lastname: Nemes
authors.forename: Erika
authors.initials: E
authors.lastname: Balázs
authors.forename: Szilvia
authors.initials: S
authors.lastname: Pintér
authors.forename: Miklós
authors.initials: M
authors.lastname: Csanády
authors.forename: Tamás
authors.initials: T
authors.lastname: Forster
mesh_terms: D000368:Aged; D000792:Angiography; D001783:Blood Flow Velocity; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology*; D003326:Coronary Circulation; D003330:Coronary Vessel Anomalies / Q000000981:diagnostic imaging; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis