Background

Vasodilator stress echocardiography (SE) allows combined evaluation of regional wall motion and Doppler coronary flow velocity reserve (CFVR) of both the left anterior descending coronary artery (LAD) and the right coronary artery (RCA). The aim of this study was to prospectively assess the prognostic correlates of LAD and RCA CFVR on SE.

Methods

A total of 1,365 patients with known or suspected coronary artery disease underwent dipyridamole SE with combined evaluation of CFVR in both the LAD and the RCA.

Results

Ischemia was present on SE in 263 patients (19%). CFVR was abnormal (≤2.0) in 545 patients (40%): 172 in the LAD only, 149 in the RCA only, and 224 in both the LAD and the RCA. During a median follow-up period of 20 months, 44 deaths and 98 myocardial infarctions occurred. In the overall population, LAD CFVR ≤ 2.0 (hazard ratio [HR], 3.93) and inducible ischemia (HR, 2.74) were multivariate prognostic predictors. In the subset with ischemia on SE, CFVR did not add to peak wall motion score index (HR, 2.23). In patients without ischemia on SE, age (HR, 1.04), anti-ischemic therapy at the time of testing (HR, 1.6) and LAD CFVR ≤ 2.0 (HR, 10.8) were independent prognostic indicators. In patients without ischemia on SE and LAD CFVR >2.0, the 4-year event rate was 4% in those with RCA CFVR > 2.0 and 18% in those with RCA CFVR ≤ 2.0 (P < .0001).

Conclusions

Ischemia on SE with high peak wall motion score index identifies a high-risk subset regardless of the underlying CFVR response. Absence of ischemia on SE is associated with intermediate risk, and LAD CFVR is essential to identify a truly low-risk subset. RCA CFVR is less useful than LAD CFVR but may have a role for further risk stratification in patients without ischemia and normal LAD CFVR.

中文翻译：

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冠脉血流储备在两个冠状动脉血管舒张应力超声心动图的预后价值。

背景

血管舒张应力超声心动图（SE）可以对左前降支冠状动脉（LAD）和右冠状动脉（RCA）的区域壁运动和多普勒冠状动脉血流速度储备（CFVR）进行综合评估。这项研究的目的是前瞻性评估LAD和RCA CFVR对SE的预后相关性。

方法

共有1,365名患有已知或疑似冠心病的患者接受了双嘧达莫SE治疗，同时对LAD和RCA中的CFVR进行了综合评估。

结果

263例患者中SE出现缺血（19％）。545位患者（40％）的CFVR异常（≤2.0）：仅LAD为172，仅RCA为149，LAD和RCA均为224。在20个月的中位随访期内，发生了44例死亡和98例心肌梗死。在总人群中，LAD CFVR≤2.0（危险比[HR]，3.93）和可诱导的局部缺血（HR，2.74）是多因素预后指标。在SE局部缺血的亚组中，CFVR并未增加壁运动评分峰值指数（HR，2.23）。对于SE无缺血的患者，年龄（HR，1.04），测试时的抗缺血治疗（HR，1.6）和LAD CFVR≤2.0（HR，10.8）是独立的预后指标。对于SE和LAD CFVR> 2.0且无缺血的患者，RCA CFVR> 2.0的患者的4年事件发生率为4％，RCA CFVR≤2.0的患者的4年事件发生率为18％（P  <.0001）。

结论

无论潜在的CFVR响应如何，具有高峰值壁运动得分指数的SE缺血都可识别高风险子集。SE缺乏缺血与中等风险相关，而LAD CFVR对于确定真正的低风险亚组至关重要。RCA CFVR的功能不如LAD CFVR好，但对于没有缺血且LAD CFVR正常的患者，RCA CFVR可能会起到进一步危险分层的作用。