Assessment of the Functional Significance of Coronary Artery Stenosis by Dobutamine-Atropine Stress Echocardiography

Abstract Background Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel. Method This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p<0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p<0.001, LCX; r=0.771, p<0.001, RCA; r=0.769, p<0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p<0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p<0.01 for LAD compared to LCX, p<0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p<0.05 for among 3 vessels). Conclusion RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice. Funding Acknowledgement Type of funding source: None

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Cardiovascular risk profiles and stress echocardiography results in patients with hypertensive response to exercise

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4183 ◽

2021 ◽

Vol 26 (5) ◽

pp. 4183

Author(s):

E. A. Karev ◽

E. G. Malev ◽

A. Yu. Suvorov ◽

S. L. Verbilo ◽

M. N. Prokudina

Keyword(s):

Cardiovascular Risk ◽

Coronary Artery ◽

Stress Echocardiography ◽

Coronary Artery Stenosis ◽

Left Ventricular ◽

Artery Stenosis ◽

Exercise Stress ◽

Volume Index ◽

High Cardiovascular Risk ◽

Response To Exercise

Aim. To compare markers of high cardiovascular risk and stress echocardiography results depending on the type of blood pressure (BP) response to exercise in patients without obstructive coronary artery disease.Material and methods. Our single-center cross-sectional study included 96 patients without hemodynamically significant coronary artery stenosis according to coronary angiography or multislice computed tomography angiography. All patients underwent physical examination, cardiovascular risk stratification, electrocardiography, extracranial cerebrovascular ultrasound, echocardiography, treadmill exercise stress echocardiography.Results. According to the test results, the patients were divided into groups with a hypertensive response (n=41) and a normal response to exercise (n=55). Patients with hypertensive response to exercise had significantly higher values of left ventricular mass index (100,0 (90,0; 107,0) g/m2 vs 76,0 (68,0; 91,0) g/m2, p<0,0000001) and left atrial volume index (36,7 (32,0; 46,0) ml/m2 vs 29,7 (26,3; 32,0) ml/m2, p=0,000003). There was also a higher level of cardiovascular SCORE risk (5,0 (2,0; 6,0) vs 2,0 (1,0; 3,0), p=0,004); patients more often had associated clinical conditions (36,6% vs 12,7%, χ2=7,57, p=0,006) and left ventricular diastolic dysfunction (39,02% vs 78,18%, χ2=15,21, p=0,0001). Pathological BP increase during stress echocardiography was associated with worse exercise tolerance (7,4 (5,6; 10,0) METs vs 10,2 (8,4; 11,95) METs, p=0,000041) and more frequent transient regional contractility impairment (46,34% vs 1,8%, p<0,00001), mainly of the lateral and inferior left ventricular walls.Conclusion. Despite the absence of coronary artery stenosis, patients with hypertensive response to exercise are significantly more likely to have markers of high cardiovascular risk and require more careful monitoring of risk factors. Also, the hypertensive response to exercise is associated with more frequent regional contractility impairment even without coronary artery stenosis.

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