Background

Coronary flow velocity reserve (CFVR) and left ventricular contractile reserve (LVCR) have demonstrated prognostic importance in patients with diabetes. The aim of this study was to investigate the prognostic contribution of combined evaluation of CFVR and LVCR in patients with diabetes with nonischemic stress echocardiography.

Methods

Three hundred seventy-five patients with diabetes (mean age, 68 ± 9 years) with nonischemic dipyridamole stress echocardiography underwent assessment of CFVR of the left anterior descending coronary artery (prospectively) and LVCR with left ventricular force (retrospectively) in a multicenter study.

Results

On receiver operating characteristic analysis, LVCR ≤ 1.1 was the best prognostic predictor and was considered an abnormal value. CFVR was abnormal (≤2) in 139 patients (37%), LVCR in 156 (42%), neither in 157 (42%), and both in 77 (21%). During a median follow-up period of 16 months, 86 major adverse cardiac events occurred: 16 deaths, 13 myocardial infarctions, and 57 revascularizations. Multivariate prognostic indicators were CFVR ≤ 2 (P < .0001), age (P = .03), and LVCR ≤ 1.1 (P = .04). The 3-year rate of major adverse cardiac events was 63% in patients with both abnormal CFVR and LVCR, 42% in those with abnormal CFVR only, 19% in those with abnormal LVCR only, and 10% in patients with both normal CFVR and LVCR. The 3-year hard event rate was 3% in patients with both normal CFVR and LVCR, fivefold higher in patients with abnormal CFVR or LVCR only, and ninefold higher in patients with both abnormal CFVR and LVCR.

Conclusions

Patients with diabetes with nonischemic dipyridamole stress echocardiography may still have significant risk in presence of abnormal CFVR and/or LVCR, which assess the underlying, largely unrelated, microvascular and myocardial components of coronary circulation.

中文翻译：

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壁式运动，冠状动脉血流速度和左心室收缩储备的一项测试的整合：血管舒张应力超声心动图对糖尿病患者的预后价值

背景

冠状动脉血流储备量（CFVR）和左心室收缩储备量（LVCR）已显示出对糖尿病患者的预后重要性。本研究的目的是探讨CFVR和LVCR联合评估对非缺血性应激超声心动图患者的预后的影响。

方法

在一项多中心研究中，对375例非缺血性双嘧达莫应力超声心动图检查的糖尿病患者（平均年龄68±9岁）进行了左冠状动脉前降支CFVR和左室力LVCR的回顾性评估。

结果

在接受者的工作特征分析中，LVCR≤1.1是最好的预后指标，并被认为是异常值。CFVR异常（≤2）139例（37％），LVCR 156例（42％），157例（42％）均无，77例（21％）均无异常。在16个月的中位随访期内，发生了86起主要的不良心脏事件：16例死亡，13例心肌梗塞和57例血运重建。多因素预后指标为CFVR≤2（P  <.0001），年龄（P  = .03）和LVCR≤1.1（P = .04）。CFVR和LVCR异常的患者的3年主要不良心脏事件发生率为63％，CFVR异常的患者为42％，LVCR异常的患者为19％，CFVR和LVCR均正常的患者为10​​％ LVCR。CFVR和LVCR均正常的患者的3年硬事件发生率为3％，CFVR或LVCR异常的患者的3年硬事件率高五倍，CFVR和LVCR异常的患者的3年硬事件率高9倍。

结论

患有非缺血性双嘧达莫应力超声心动图检查的糖尿病患者，如果存在异常的CFVR和/或LVCR，仍可能存在重大风险，这将评估冠状动脉循环的基本，基本不相关的微血管和心肌成分。