Reduction of Coronary Flow Velocity Reserve as the Main Driver of Prognostically Beneficial Coronary Revascularization - 02/01/25
, Nicola Gaibazzi, MD b, Quirino Ciampi, MD, PhD c, Fausto Rigo, MD d, Domenico Tuttolomondo, MD b, Francesco Bovenzi, MD a, Dario Gregori, PhD e, Scipione Carerj, MD f, Mauro Pepi, MD g, Patricia A. Pellikka, MD h, Eugenio Picano, MD, PhD ion behalf of the
Stress Echo 2030 study group
Abstract |
Background |
Regional wall motion abnormality (RWMA) can be absent during stress echocardiography (SE) in patients with chronic coronary syndromes (CCS) and angiographically significant coronary artery disease (CAD) despite a reduction of coronary flow velocity reserve (CFVR).
Objectives |
To assess the value of a physiology-driven approach, based on CFVR, to coronary revascularization in patients with physiologically and anatomically significant disease of the left anterior descending (LAD) coronary artery.
Methods |
In a 3-center, observational study with retrospective analysis of prospectively acquired data, 749 patients with CCS, CFVR of the LAD ≤2.0, and ≥50% diameter stenosis of the LAD were enrolled. All patients were evaluated with dipyridamole (0.84 mg/kg in 6’) SE. Patients were followed for 6.4 ± 4.5 years for the outcome of all-cause death.
Results |
Inducible RWMA was present in 295 patients (39%). Coronary flow velocity reserve was lower in patients with inducible RWMA compared to those without (1.51 ± 0.28 vs 1.65 ± 0.25; P < .001). Coronary revascularization was performed in 514 (69%) patients (388 with percutaneous coronary intervention, 126 with coronary artery bypass surgery). Of them, 226 exhibited inducible RWMA and 288 exhibited isolated reduction of CFVR. During the follow-up, 185 (25%) deaths occurred. The 10-year survival in the entire study population was 70%. The survival at 10 years was markedly lower in conservatively treated patients compared to invasively treated patients (53 vs 76%; P < .0001), with no significant difference between those with solitary reduction of CFVR and reduction of CFVR accompanied by concurrent inducible RWMA. Propensity score–weighted all-cause mortality risk was significantly higher for conservative than for invasive strategy (propensity score adjusted hazard ratio = 2.12; 95% CI, 1.51–2.96; P < .0001).
Conclusions |
In patients with CCS and physiologically and anatomically significant LAD disease, coronary revascularization driven by a reduction in CFVR is accompanied by a prognostic benefit independently of the presence of inducible RWMA.
Le texte complet de cet article est disponible en PDF.Central Illustration |
Middle upper panel: The propensity score–weighted Kaplan-Meier survival curves in invasively and conservatively treated patients with reduction of CFVR of the LAD. Middle lower panel: The annualized death rate stratified on the basis of the presence or absence of inducible RWMA in the conservative strategy and invasive strategy groups. Right upper panel: The SE inclusion criterion: a reduced CFVR in the LAD. Right lower panel: The angiographic inclusion criterion: a significant stenosis of the LAD (indicated by a yellow arrow).
Middle upper panel: The propensity score–weighted Kaplan-Meier survival curves in invasively and conservatively treated patients with reduction of CFVR of the LAD. Middle lower panel: The annualized death rate stratified on the basis of the presence or absence of inducible RWMA in the conservative strategy and invasive strategy groups. Right upper panel: The SE inclusion criterion: a reduced CFVR in the LAD. Right lower panel: The angiographic inclusion criterion: a significant stenosis of the LAD (indicated by a yellow arrow).
Central IllustrationMiddle upper panel: The propensity score–weighted Kaplan-Meier survival curves in invasively and conservatively treated patients with reduction of CFVR of the LAD. Middle lower panel: The annualized death rate stratified on the basis of the presence or absence of inducible RWMA in the conservative strategy and invasive strategy groups. Right upper panel: The SE inclusion criterion: a reduced CFVR in the LAD. Right lower panel: The angiographic inclusion criterion: a significant stenosis of the LAD (indicated by a yellow arrow).Le texte complet de cet article est disponible en PDF.
Highlights |
• | Transthoracic Doppler echocardiography evaluates coronary flow velocity. |
• | Mid-distal segment of the LAD coronary artery is the target. |
• | Anatomy-driven coronary revascularization gives no survival benefit. |
• | Wall motion abnormalities–driven coronary revascularization gives no survival benefit. |
• | Physiology-driven coronary revascularization gives substantial survival benefit. |
Keywords : Coronary flow velocity reserve, Coronary revascularization, Dipyridamole, Left anterior descending artery, Prognosis
Abbreviations : CABG, CAD, CCS, CFVR, HR, LAD, LV, LVEF, PCI, RWMA, SE, WMSI
Plan
| Travel, publication, and infrastructural funding came from Società Italiana di Ecocardiografia e Cardiovascular Imaging. |
|
| Rosa Sicari, MD, PhD, served as guest editor for this report. |
Vol 38 - N° 1
P. 24-32 - janvier 2025 Retour au numéro
Article précédent
- Cardiac Function and Functional Capacity in Patients With Long COVID: A Comparison to Propensity-Matched Community Controls
- Thomas H. Marwick, Noah Wexler, Joel Smith, Leah Wright, Felicia Ho, Marc Oreto, Ashleigh-Georgia Sherriff, Richard Allwood, Yusuke Sata, Stefano Manca, Erin Howden, Quan Huynh
- Three-Dimensional Transthoracic Echocardiography for Semiautomated Analysis of the Tricuspid Annulus: Validation and Normal Values
- Juan I. Cotella, Alexandra Blitz, Alexandra Clement, Michele Tomaselli, Denisa Muraru, Luigi P. Badano, Natascha Sauber, Adria Font Calvarons, Markus Degel, Agnieszka Rucki, Michael Blankenhagen, Megan Yamat, Marcus Schreckenberg, Karima Addetia, Federico M. Asch, Victor Mor-Avi, Roberto M. Lang, WASE Investigators, Aldo D. Prado, Eduardo Filipini, Ricardo E. Ronderos, Agatha Kwon Samantha Hoschke-Edwards, Gregory M. Scalia, Tania Regina Afonso, Ana Clara Tude Rodridugues, Babitha Thampinathan, Maala Sooriyakanthan, Wendy Tsang, Yingbin Wang, Yu Zhang, Tiangang Zhu, Zhilong Wang, R. Alagesan, S. Balasubramanian, R.V.A. Ananth, Vivekanandan Amuthan, Manish Bansal, Ravi R. Kasliwal, Azin Alizadehasl, Anita Sadeghpour, Eduardo Bossone, Tomoko Nakao, Takayuki Kawata, Megumi Hirokawa, Naoko Sawada, Masao Daimon, Yousuke Nabeshima, Masaki Takeuchi, Pedro Gutierrez Fajardo, Kofo O. Ogunyankin, Edwin S. Tucay, Hye Rim Yun, Seung Woo Park, Ji-won Hwang, Mark J. Monaghan, James N. Kirkpatrick, Tatsuya Miyoshi
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?