Long-term prognostic value of coronary flow velocity reserve in patients with hypertrophic cardiomyopathy: 9-year follow-up results from SZEGED study

2009 ◽  
Vol 24 (5) ◽  
pp. 352-356 ◽  
Author(s):  
Attila Nemes ◽  
Erika Balázs ◽  
Osama I. I. Soliman ◽  
Róbert Sepp ◽  
Miklós Csanády ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity

Prognostic role of coronary flow velocity reserve in hypertrophic cardiomyopathy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Tesic ◽  
Q Ciampi ◽  
A Djordjevic-Dikic ◽  
B Beleslin ◽  
L Cortigiani ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Flow Velocity ◽  
Wall Thickness ◽  
Coronary Flow ◽  
Multivariable Analysis ◽  
Coronary Microvascular Dysfunction ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity ◽  
Maximal Wall Thickness

Abstract Background A reduction in coronary flow velocity reserve (CFVR) related to coronary microvascular dysfunction is a major mechanism for ischemia in hypertrophic cardiomyopathy (HCM). Hypothesis To assess the functional correlates and prognostic value of CFVR during stress echocardiography (SE) in HCM. Methods We enrolled 201 HCM patients (age 51±14 years, 105 male, 52%; maximal wall thickness: 18±3 mm) studied with CFVR during exercise (n=33, 16.4%), dipyridamole (n=89, 44.3%) or adenosine (n=79, 39.3%) SE in 6 certified centers. CFVR was assessed using pulsed wave Doppler sampling in left anterior descending coronary artery. All patients completed the clinical follow-up. Results During SE mean value of CFVR was 2.11±0.46. No patients showed regional wall motion abnormalities during stress. LV outflow tract obstruction (LVOTO) was present in 34 (16.9%) patients at rest and in 47 (23.4%) at peak stress. CFVR was inversely related to age (r=−0.229, p=0.001) and maximal wall thickness (r=−0.197, p=0.031). During a median follow-up of 26 months (IQ range: 12–48 months), 75 events in 63 patients occurred: 10 deaths, 33 new hospital admission for acute heart failure, 8 sustained ventricular tachycardias and 24 atrial fibrillations. Patients in the lowest tertile (≤1.88) showed the worse prognosis with higher incidence of follow-up events compared to median tertile (1.89–2.29) and highest tertile (≥2.30) (see figure). At multivariable analysis, NYHA functional class (HR: 2.234, 95% CI: 1.398–3.517, p=0.001), presence of LVOTO at rest (HR: 2.958, 95% CI: 1.074–3.570, p=0.028) and lowest tertile of CFVR (HR: 2.144, 95% CI: 1.126–4.081, p=0.011) were the independent predictors of follow-up events. Conclusions In HCM patients, reduction in CFVR is associated to a clearly worse outcome. The spectrum of prognostic stratification is expanded if the response is titrated according to a continuous scale. Figure 1 Funding Acknowledgement Type of funding source: None

P1502Age- and gender-specific prognostic cutoff values of coronary flow velocity reserve in vasodilator stress echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Lombardo ◽  
L Cortigiani ◽  
Q Ciampi ◽  
F Rigo ◽  
F Bovenzi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Stress Echocardiography ◽  
Age Groups ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity ◽  
Cutoff Values ◽  
Age And Sex

Abstract Background Coronary flow velocity reserve (CFVR) of left anterior descending artery is useful for risk stratification during stress echocardiography (SE) as an add-on to regional wall motion abnormalities (RWMA), but the age-and sex-dependence of prognostic cutoff values remains unclear. Purpose To provide sex and age-specific prognostic cut-off values which may be needed to account for the physiologic decline of CFVR with age, and sex-related differences in resting flow. Methods In an observational, prospective, multicenter, registry study design, we enrolled from August 2003 to August 2017 in 4 Italian cardiology referral centers with accredited, quality-controlled stress echo laboratory a consecutive sample of 5,577 patients (of them, 2,284 women and 110 aged ≥85 years) referred to the SE lab for known or suspected coronary artery disease, after exclusion of patients with inadequate acoustic window (n=295), premature test interruption (n=105), and lost to follow-up (n=173).All underwent dual imaging (RWMA and CFVR) dipyridamole SE (0.84 mg/kg over 6') and were followed-up. All-cause death and non-fatal myocardial infarction were the main outcome measures. Median follow-up of 20 months (1st quartile 8, 3rd quartile 43 months), Results There were 649 hard events (236 deaths and 413 non-fatal myocardial infarctions), 288 of which occurred in women and 38 in patients ≥85 years. With a ROC analysis, the best prognostic cut-off value for CFVR was almost the same 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 the very elderly (>85 years) who showed an optimal value of 1.90. Independent prognostic indicators were RWMA (HR=5.42, 95% CI=2.42–12.15; p<0.0001) and reduced CFVR (HR=3.26, 95% CI 2.27–3.90; p<0.0001) in patients aged <85 years, and RWMA (HR=5.42, 95% CI=2.42–12.15; p<0.0001) in patients aged >85 years. Best prognostic cut-off value of CFVR Conclusion A sex-independent cut-off value of CFVR ≤2.0 provides the optimal risk stratification across all age groups, except those >85 years in whom a lower cut-off <1.90 is needed. Risk stratification is more effective for all age groups when CFVR is combined with RWMA.

scholarly journals Prognostic value of calcium score and coronary flow velocity reserve in asymptomatic diabetic patients

2015 ◽  
Vol 13 (1) ◽  
Author(s):  
Miodrag Dikic ◽  
Milorad Tesic ◽  
Zeljko Markovic ◽  
Vojislav Giga ◽  
Ana Djordjevic-Dikic ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Prognostic Value ◽  
Calcium Score ◽  
Diabetic Patients ◽  
Coronary Flow Velocity Reserve ◽  
Coronary Flow Velocity

Abstract 4910: Integrated Approach By Using Coronary Flow Velocity Reserve And Coronary Flow Velocity Patterns In Predicting Long-term Adverse Cardiac Events In Acute Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Myeong Ho Yoon ◽  
Seung-Jea Tahk ◽  
Hong-Seok Lim ◽  
Jin-Sun Park ◽  
Hyeong-Mo Yang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Integrated Approach ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Coronary Flow Velocity ◽  
Adverse Cardiac Events

Background: The microvascular function was known to be an useful predictor of left ventricular functional changes and clinical outcomes in ST-segment elevation myocardial infarction (STEMI). We evaluated the usefulness of integrated approach by using coronary flow velocity reserve (CFR) and diastolic deceleration time (DDT) in the prediction of long-term major adverse cardiac events in STEMI. Methods and Results: Using an intracoronary Doppler wire, CFR, DDT and hyperemic microvascular resistance index (MVRI) were evaluated in 202 patients with first STEMI received reperfusion therapy within 24 hours after onset of symptoms. Major adverse cardiac events were the composite of cardiac death, recurrent myocardial infarction, congestive heart failure and stroke during an average follow-up period of 60 ± 39 months. Follow-up echocardiography was performed at 12 ± 9 months. CFR, DDT and MVRI had significant correlations with left ventricular regional wall motion score index at follow-up echocardiography (r =−0.441, p<0.001; r = 0.413, p<0.001; r =−0.485, p<0.001, respectively). Using receiver-operating characteristics analysis, CFR ≤1.3 (sensitivity: 51%, specificity: 78%), DDT ≤577 ms (sensitivity: 72%, specificity: 62%) and MVRI >2.7 (sensitivity: 68%, specificity: 67%) were the best cutoff values in the prediction of occurring the adverse cardiac events. In patients with CFR ≤1.3, DDT ≤577 ms, cardiac events were occurred in 18 patients (40.0 %) of 45 patients, whereas cardiac events were occurred in 12 patients (20.3%) of 59 patients with CFR >1.3 and DDT ≤577 ms or CFR ≤1.3 and DDT >577 ms (p= 0.048), 9 patients (9.1%) of 99 patients with CFR>1.3 and DDT >577 ms (p<0.001). Ejection fraction at admission (p=0.009), MVRI (p =0.002) and DDT (p=0.023) were independent predictors in the prediction of long-term adverse cardiac outcomes during follow-up. Conclusions: Integrated approach by using CFR and DDT was useful in the prediction of long-term adverse cardiac events. MVRI and DDT were strong independent predictors of long-term adverse cardiac events in STEMI patients.

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