Coronary flow velocity reserve (CFVR) can be measured noninvasively using stress transthoracic Doppler echocardiography (S-TDE). The prognostic significance of S-TDE-derived CFVR after percutaneous coronary intervention (PCI) remains unknown. The aim of this study was to investigate the prognostic value of post-PCI CFVR and its additional efficacy to fractional flow reserve (FFR) in patients undergoing elective PCI. A retrospective study was conducted involving 187 consecutive patients with chronic coronary syndrome who underwent elective PCI guided by FFR for the left anterior descending coronary artery. Pre- and post-PCI wire-based FFR and CFVR assessments of the left anterior descending coronary artery using S-TDE were performed in all patients. The association between post-PCI clinical and physiologic parameters and major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure, and unplanned remote target vessel revascularization, was evaluated. Three-quarters of patients exhibited CFVR increase after PCI, while all patients showed FFR improvement. During a median follow-up period of 1.5 years, MACE occurred in 21 patients (11.2%). Among clinical demographics, patients with MACE had higher levels of N-terminal pro–brain natriuretic peptide compared with those without MACE (median, 615 pg/mL [interquartile range, 245-1,500 pg/mL] vs 180 pg/mL [interquartile range, 70-559 pg/mL]; = .010). Post-PCI S-TDE-derived CFVR was lower in patients with MACE, while post-PCI FFR showed a nonsignificant tendency to be lower in patients with MACE. In a multivariable analysis, higher NT-proBNP (adjusted hazard ratio, 1.33; 95% CI, 1.02-1.74; = .038), post-PCI CFVR ≤ 2.0 (adjusted hazard ratio, 2.93; 95% CI, 1.16-7.40; = .023), and post-PCI FFR ≤ 0.82 (adjusted hazard ratio, 3.93; 95% CI, 1.52-10.18; = .005) were independently associated with MACE. In patients with chronic coronary syndrome who underwent successful elective PCI for left anterior descending coronary artery, the combined assessment of S-TDE-derived post-PCI CFVR and post-PCI FFR provided a significant association with the occurrence of MACE.

中文翻译：

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药物洗脱支架植入后血流储备分数和冠状动脉血流速度储备的联合评估

冠状动脉血流速度储备 (CFVR) 可以使用负荷经胸多普勒超声心动图 (S-TDE) 无创测量。经皮冠状动脉介入治疗 (PCI) 后 S-TDE 衍生的 CFVR 的预后意义仍不清楚。本研究的目的是调查 PCI 术后 CFVR 的预后价值及其对择期 PCI 患者血流储备分数 (FFR) 的额外功效。一项回顾性研究纳入了连续 187 名慢性冠状动脉综合征患者，他们接受了 FFR 引导下的左冠状动脉前降支择期 PCI 治疗。使用 S-TDE 对所有患者进行 PCI 术前和术后基于线的 FFR 和 CFVR 评估。评估了 PCI 术后临床和生理参数与主要不良心脏事件 (MACE) 之间的关联，MACE 定义为心源性死亡、心肌梗死、心力衰竭和非计划远程靶血管血运重建的复合事件。四分之三的患者在 PCI 后表现出 CFVR 增加，而所有患者的 FFR 均有所改善。在中位随访 1.5 年期间，21 名患者 (11.2%) 发生 MACE。在临床人口统计学中，与无 MACE 的患者相比，患有 MACE 的患者的 N 端脑钠肽前体水平较高（中位数为 615 pg/mL [四分位数范围，245-1,500 pg/mL] vs 180 pg/mL [四分位数范围] ，70-559 pg/mL]；= .010)。 PCI 后 S-TDE 衍生的 CFVR 在 MACE 患者中较低，而 PCI 后 FFR 在 MACE 患者中显示出不显着的降低趋势。在多变量分析中，NT-proBNP 较高（调整后风险比，1.33；95% CI，1.02-1.74；= 0.038），PCI 后 CFVR ≤ 2.0（调整后风险比，2.93；95% CI，1.16-7.40；= 0.038）。 = .023）和 PCI 后 FFR ≤ 0.82（调整后风险比，3.93；95% CI，1.52-10.18；= .005）与 MACE 独立相关。在成功接受冠状动脉左前降支择期 PCI 的慢性冠状动脉综合征患者中，S-TDE 衍生的 PCI 后 CFVR 和 PCI 后 FFR 的综合评估与 MACE 的发生显着相关。