scholarly journals Comparison of coronary flow reserve feasibility and values in different stress echocardiography protocols: dobutamine, dipyridamole, exercise and rapid pacing

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Wierzbowska-Drabik ◽  
E Picano ◽  
L Cortigiani ◽  
J.D Kasprzak
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Pharmacological Stress ◽  
Coronary Flow Velocity ◽  
Funding Sources ◽  
Flow Reserve ◽  
Rapid Pacing ◽  
Diastolic Coronary Flow

Abstract Background and aims To compare the feasibility of Coronary Flow Velocity Reserve (CFVR) assessment in the left anterior descending (LAD) artery in four types of stress echocardiography (SE): dobutamine (DOB), dipyridamole (DIP), rapid pacing (PAC) and bicycle exercise (EXE). Methods and results We subjected 369 patients (mean age: 67±11 years) to SE with DOB (up to 40 mcg/kg/min, n=230), DIP (0.84 mg/kg, n=73), PAC (n=22) or EXE (n=44). CFVR was measured as the ratio of peak diastolic coronary flow velocity (CFV) during exercise, pharmacological stress or pacing and peak diastolic CFV at rest in distal or mid LAD. The feasibility was excellent during PAC (100%), DOB (95%) and DIP (95%) and lower during EXE (73%, p<0.01 vs other groups) when assessed in all consecutive patients. When assessed in patients having readable LAD flow at rest the feasibility achieved even higher values, being however still lowered in EXE group, see Figure 1. In multivariate analysis only the EXE protocol was a predictor of LAD flow loss during SE, with OR = 8.23 (95% CI 2.17 – 31.33), p=0.0019. CFVR was lower with PAC (1.8±0.4) as compared to DIP (2.2±0.6, p=0.0061) and DOB (2.2±0.6, p=0.0025), but similar to EXE (2.0±0.6, p=0.178), and correlated best with the peak heart rate in EXE and PAC, see Figure 2. Conclusion CFVR in LAD can be obtained during all forms of SE, but the feasibility is significantly higher with PAC and pharmacological tests as compared to EXE, which was identified in our study as the independent predictor of the loss of LAD flow recording at the peak of stress test. Moreover, CFVR values were the lowest in PAC group which however encompassed the older patients with more advanced coronary artery disease. Significant correlation between HR and CFVR observed in EXE and PAC suggests that in this type of SE cut-off value of CFVR should be probably indexed to maximal HR achieved. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eiji Ichimoto ◽  
Nao Konagai ◽  
Sawako Horie ◽  
Atsushi Hasegawa ◽  
Hirofumi Miyahara ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Flow Ratio ◽  
Operating Characteristics ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Introduction: Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis. Hypothesis: We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis. Methods: A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts. Results: There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80. Conclusions: QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.

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.

Effects of aging on coronary flow reserve in patients with no evidence of myocardial perfusion abnormality

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Ramandika ◽  
S Kurisu ◽  
K Nitta ◽  
T Hidaka ◽  
H Utsunomiya ◽  
...  
Keyword(s):  
Myocardial Perfusion ◽  
Flow Velocity ◽  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Perfusion Abnormality ◽  
Coronary Flow Velocity ◽  
Group Iii ◽  
Flow Reserve ◽  
Group I ◽  
Myocardial Perfusion Abnormality

Abstract Background Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. Purpose We tested the hypothesis that aging had impacts on coronary flow velocities and CFR in patients with no evidence of myocardial perfusion abnormality on single photon emission computed tomography (SPECT). Methods and results Seventy-six patients with no evidence of myocardial perfusion abnormality on SPECT undergoing transthoracic Doppler echocardiography were enrolled in this study. Patients were divided into three age groups: 17 patients aged &lt;70 years (Group I), 38 patients aged 70–79 years (Group II), and 21 patients aged ≥80 years (Group III). Compared with Group I, CFR was significantly lower in Group II (P&lt;0.01) and Group III (P&lt;0.01). Multivariate analysis showed that female (P=0.03), cigarette smoking (P=0.004), hemoglobin level (P=0.001) and LV mass index (P=0.03) were determinants for resting coronary flow velocity. On the other hand, age (P=0.008), hemoglobin level (P&lt;0.001) and LV mass index (P=0.04) were determinants for hyperemic coronary flow velocity. Age was only independent determinant for CFR (β=−0.48 P&lt;0.001). Conclusions Our data suggested that aging impaired CFR in patients with no evidence of myocardial perfusion abnormality primarily due to the decrease in hyperemic coronary flow velocity. Comparison of coronary flow reserve amon Funding Acknowledgement Type of funding source: None

Stress echocardiography: introduction and pathophysiology

2016 ◽  
Author(s):  
Rosa Sicari ◽  
Raluca Dulgheru
Keyword(s):  
Stress Echocardiography ◽  
Imaging Modality ◽  
Stress Test ◽  
Cost Effective ◽  
Left Ventricular ◽  
Pharmacological Stress ◽  
Electrical Stress ◽  
Prognostic Accuracy ◽  
Flow Reserve ◽  
Training Stress

Stress echocardiography is the combination of two-dimensional echocardiography with a physical, pharmacological, or electrical stress. The diagnostic end point for the detection of myocardial ischaemia is the induction of a transient worsening in left ventricular regional function during stress. Among different stress modalities of comparable diagnostic and prognostic accuracy available, semisupine exercise is the most frequently used; dobutamine-the best test for viability assessment; dipyridamole-the safest and simplest pharmacological stress test; and the most suitable for combined wall motion-coronary flow reserve assessment. Identification of viable myocardium and evaluation of severity of valvular heart disease are additional recognized applications of stress echocardiography. In spite of its dependence upon operators’ training, stress echocardiography is today the best (most cost-effective and risk-effective) possible imaging modality to achieve the still elusive target of sustainable cardiac imaging in the field of non-invasive diagnosis of coronary artery disease.

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