BACKGROUND Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high-dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non-CV conditions. We aimed to assess whether CFVR is associated with all-cause death, but more specifically with CV, cancer, and non-CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables. METHODS One thousand two patients who underwent stress echocardiography were followed for a median of 8.2 years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow-up was also analyzed (n = 752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality. RESULTS A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR < 2 was significantly associated with each category of cause-specific mortality. A CFVR < 2 or ≥2 separated a group of patients with 8-year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality. CONCLUSIONS The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.

中文翻译：

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冠状动脉血流速度储备降低与心血管、癌症和非癌症、非心血管死亡率相关。

背景 在高剂量血管扩张剂负荷超声心动图期间在左前降支中测量的冠状动脉血流速度储备 (CFVR) 询问心外膜和微循环冠状动脉功能，并且与慢性炎症和微血管功能障碍以及阻塞性冠状动脉的存在呈负相关。动脉疾病。微血管功能障碍和慢性炎症是心血管 (CV) 和非 CV 疾病的常见疾病机制。我们旨在评估 CFVR 是否与全因死亡相关，但更具体地说与心血管、癌症以及非心血管和非癌症 (NCVNC) 死亡率相关，独立且越来越多地超过其他人口统计学、临床和超声心动图变量。方法 1002 名接受负荷超声心动图检查的患者中位时间为 8.2 年，具有临床、局部室壁运动异常 (RWMA) 和 CFVR 数据。对 RWMA 和 CFVR 对 CV、癌症或 NCVNC 死亡率的独立预后价值进行了评估，调整了临床变量。还分析了在随访期间没有进行 RWMA 或血运重建手术的预先指定的受试者亚组（n = 752），以排除大多数可能患有冠状动脉疾病的参与者，并从评估 CFVR 和死亡率的潜在关联中消除这种混杂因素。结果 共有 161 名患者 (16%) 死亡，其中 63 名死于 CV (39%)，52 名死于癌症 (32%)，46 名 (29%) 死于 NCVNC。与 CV 死亡率相比，在单变量分析中，癌症和 NCVNC 死亡率与缺血性 RWMA 无关，而 CFVR < 2 与每类原因特异性死亡率显着相关。CFVR < 2 或≥2 将一组患者的 8 年心血管死亡率分别为 14.6% 和 1.2%、癌症死亡率分别为 10.3% 和 0.4%、NCVNC 死亡率分别为 9.5% 和 1.5%。结论 在临床上因疑似/已知冠状动脉疾病转诊的人群中，CFVR 的降低与 CV、癌症和 NCVNC 死亡独立相关。CFVR 可以作为一种标志物或机制，用于预测和预测各种疾病的死亡率。3% 与 0.4% 的癌症死亡率，以及 9.5% 与 1.5% 的 NCVNC 死亡率。结论 在临床上因疑似/已知冠状动脉疾病转诊的人群中，CFVR 的降低与 CV、癌症和 NCVNC 死亡独立相关。CFVR 可以作为一种标志物或机制，用于预测和预测各种疾病的死亡率。3% 与 0.4% 的癌症死亡率，以及 9.5% 与 1.5% 的 NCVNC 死亡率。结论 在临床上因疑似/已知冠状动脉疾病转诊的人群中，CFVR 的降低与 CV、癌症和 NCVNC 死亡独立相关。CFVR 可以作为一种标志物或机制，用于预测和预测各种疾病的死亡率。