BACKGROUND: The measurement of the left ventricular ejection fraction during at echocardiographic study evaluates global contractility. A decrease in this parameter indicates a poor prognosis. However, in the range of normal values, the left ventricular ejection fraction loses prognostic significance. This category of patients requires the development of other prognostic methods. AIM: To explore the effect of changes in coronary blood flow parameters measured using dopplerography in patients with preserved left ventricular ejection fraction in predicting adverse outcomes over the next year. MATERIALS AND METHODS: The prospective study included patients referred for echocardiography in 20192020 followed up at the Saint Petersburg Research Center of Cardiology Medika. The inclusion criterion was age over 18 years. A decrease in left ventricular ejection fraction of less than 53% was an exclusion critrion. In addition to standard echocardiography, dopplerography has been used to study the velocity parameters of blood flow in the coronary arteries. The observation period was 1 year. RESULTS: The control group included 453 patients. During the year of observation, 89 cases of spontaneous adverse events (death / myocardial infarction / progressive heart failure) occurred, including 19 deaths. The patients who died were older (76.6 8.6 vs. 59.3 15.5 years; р 0.000001), with lower global longitudinal function (13.8 4.3% vs. 18.3 3.6%, р 0.000001), with a large volume index of the left atrium (54.6 15.5 vs. 36.5 13.1 ml/m2; р 0.000000), high pressure in the pulmonary artery (39 14.7 vs. 29.5 8.1 mmHg; р 0.000000), high left ventricular myocardial mass index (108.7 37.2 vs. 88,1 24.1 g/m2, р 0.000000) and impaired diastolic function [the ratio of blood flow velocity through the mitral valve in the first (early) phase of left ventricular filling and the average velocity of the mitral valve fibrous ring 13.6 7.1 vs. 9.4 4.4; р 0.000000]. The blood flow velocity in the anterior interventricular artery was significantly higher (78.0 39.0 vs. 50.0 25.4 cm/s, р 0.000007). Only age and flow velocity in anterior interventricular artery were independent predictors of death / myocardial infarction (р 0.004). CONCLUSIONS: Velocity parameters in the anterior interventricular artery are a significant predictor of short-term spontaneous events, including death, in patients with preserved ejection fraction.
Aim. The goals of this research are to define the frequency of the coronary arteries visualization possibilities depending on various factors at routine echocardiography and estimate to the relation of coronary flow ultrasound parameters to prognosis of the adverse outcomes in the subsequent year.Material and methods. The study comprises 581 consecutive patients. All patients performed echocardiography following standard method with an additional tab called «Coronary» which was set to visualize coronary arteries. Also all patients underwent a standard examination and debriefing of anamnesis. Observation of patients was the next year after echocardiography. The end points in the study – death from any cause, myocardial infarction (MI), death/ MI, myocardial revascularization operations - stenting and aortocoronary bypass (CABG). The analysis of clinical outcomes was carried out using the study of medical history and outpatient cards, interviewing patients at the time of admission, as well as the method of telephone survey of patients or their next of kin. ROC analysis as well as subgroup survival analysis using the Kaplan-Meier method was performed.Results. The possibility to visualize the segments of coronary arteries and to estimate the coronary flow was in 91% of cases, or 526 patients. Women predominated among the patients (59.7% versus 40.3%). During follow-up, 73 patients recorded endpoints: 23 people died, 4 patients suffered non-fatal MI. 24 patients underwent CABG, 22 patients – myocardial revascularization. Depending on the quartile distribution by body mass index and age, a significant difference in visualization was not identified. Mortality was observed significantly more frequent when the flow velocity in the left coronary artery/proximal left artery descending/circumflex artery was higher than 64 cm/s. Flow velocity in left coronary artery /proximal left artery descending 64 cm/s was the cut-off value predicting MI with 100% sensitivity, 73,4% specificity (p<0.0001). Conclusion. Coronary flow velocity parameters provide long-term prognostic value that can be used to identify individuals with high risk of developing adverse cardiovascular events. Key words: coronary flow velocity, echocardiography, coronary artery, adverse events>˂0.0001).Conclusion. Coronary flow velocity parameters provide long-term prognostic value that can be used to identify individuals with high risk of developing adverse cardiovascular events.
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