PURPOSE Coronary flow velocity reserve (CFVR) of the left anterior descending artery is useful for risk stratification during stress echocardiography (SE) as an add-on to regional wall motion abnormalities (RWMA). We sought to provide sex- and age-specific prognostic cutoff values for CFVR. METHODS A total of 5,577 patients (2,284 women; 110 age ≥ 85 years) who underwent dipyridamole SE with evaluation of RWMA and CFVR were enrolled in a multicenter prospective SE registry. Death and myocardial infarction were the clinical end points. RESULTS During 20 months' median follow-up, 649 events (236 deaths, 413 infarctions) occurred: 288 in women and 38 in patients ≥85 years. At receiver operating characteristics analysis, the best prognostic cutoff value for CFVR was similar for men (2.03) and women (2.02) and consistent across all age strata (<45 years: 2.03; 45-54 years: 2.04; 45-64 years: 2.03; 65-74 and 75-84 years: 2.0) except for patients >85 years, who showed 1.90 as the optimal value. Independent predictors of mortality or myocardial infarction were RWMA (hazard ratio [HR] = 5.42), reduced CFVR (HR = 3.26), resting ejection fraction (HR = 0.98), smoking habit (HR = 1.41), age (HR = 1.02), and prior percutaneous coronary intervention (HR = 1.20) in patients age <85 years; and RWMA (HR = 5.42), smoking habit (HR = 3.24), and resting ejection fraction (HR = 0.97) in those age ≥85 years. CFVR added a prognostic contribution over clinical parameters, resting ejection fraction, and stress-induced RWMA in all age and sex groups except men >85 years. CONCLUSIONS A sex-independent value of CFVR ≤2.0 provides the optimal prognostication across all age groups, except for those ≥85 years in whom a cutoff ≤1.90 is needed. Risk stratification is more effective for all age groups when CFVR is combined with RWMA.

中文翻译：

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血管扩张剂超声心动图中按年龄和性别划分的冠状动脉血流速度储备的预后临界值。

目的左前降支的冠状动脉血流速度储备（CFVR）作为应激性超声心动图（SE）期间的危险分层，可作为区域壁运动异常（RWMA）的补充。我们试图提供针对CFVR的性别和年龄特定的预后临界值。方法总共对5577名患者（2284名女性； 110岁≥85岁）行双嘧达莫SE评估RWMA和CFVR纳入多中心前瞻性SE登记。死亡和心肌梗塞是临床终点。结果在20个月的中位随访期间，发生649例事件（236例死亡，413例梗塞）：女性288例，≥85岁的患者38例。在接受者操作特征分析中，CFVR的最佳预后临界值在男性（2.03）和女性（2.）中相似。02），并且在所有年龄层（<45岁：2.03； 45-54岁：2.04； 45-64岁：2.03； 65-74和75-84岁：2.0）保持一致，但> 85岁的患者表现为1.90作为最佳值。死亡率或心肌梗死的独立预测因子是RWMA（危险比[HR] = 5.42），CFVR降低（HR = 3.26），射血分数（HR = 0.98），吸烟习惯（HR = 1.41），年龄（HR = 1.02） <85岁的患者，以及先前的经皮冠状动脉介入治疗（HR = 1.20）；和RWMA（HR = 5.42），吸烟习惯（HR = 3.24）和≥85岁年龄组的静息射血分数（HR = 0.97）。CFVR对所有年龄段和性别组（> 85岁以上的男性）的临床参数，静息射血分数和应激诱导的RWMA的预后做出了贡献。结论CFVR≤2的性别无关值。0为所有年龄组提供最佳的预后，但≥85岁且需要截止≤1.90的年龄除外。当CFVR与RWMA结合使用时，风险分层对所有年龄段的人群都更有效。