Prognostic value of proximal left coronary artery flow velocity detected by transthoracic Doppler echocardiography

Abstract

BackgroundLesions in the proximal left coronary artery (LCA) are associated with a poor prognosis compared with other lesional sites. Transthoracic Doppler echocardiography (TTDE) can help to detect proximal LCA flow, and an accelerated coronary flow velocity (CFV) indicates the presence of proximal LCA lesions. This study aimed to investigate the prognostic value of CFV in the proximal LCA measured by TTDE.MethodsWe enrolled 1472 consecutive hemodynamically stable patients with known or suspected heart disease whose CFV was successfully detected using TTDE accompanied by routine echocardiography between 2008 and 2011. The primary outcome was cardiac death (acute myocardial infarction, heart failure, or sudden cardiac death) and patients were followed up over a median of 6.3 years.ResultsOverall, 42 cardiac deaths (3%) were observed. An increased CFV was significantly associated with the outcome in several models based on potential confounders (age, rate pressure product, Framingham Risk Score, diabetes, coronary artery disease, hemoglobin, brain natriuretic peptide, estimated glomerular filtration rate, left ventricular mass, left ventricular ejection fraction, and E/e′). Using a receiver operating characteristic curve analysis, the optimal cut-off value for the CFV to the association of the outcome was 37 cm/s (area under the curve, 0.70; sensitivity, 82%; specificity, 62%). In sequential Cox proportional hazards models, the CFV added incremental prognostic information to the clinical and basic echocardiographic parameters (chi-squared: 110.7 to 146.6, P < 0.01).ConclusionsAn increased CFV in the proximal LCA was associated with cardiac death, incremental to the clinical and basic echocardiographic parameters.

The Role of Myocardial Revascularization in the Survival of Patients With Altered Coronary Blood Flow Detected by Transthoracic Ultrasound

“…На сегодняшний день в доступной литературе опубликовано только две работы, посвященные данной теме: проспективное контролируемое исследование, субанализ которого приводится в нашей работе, и одноцентровый анализ когорты пациентов, проведенный T. Morofuju и соавт. [14]. Несмотря на присущие ретроспективному анализу ограничения второго исследования, авторам удалось на большой выборке пациентов показать, что высокие скорости кровотока в проксимальном отделе ствола ЛКА и передней нисходящей артерии ассоциированы со смертью и являются независимым предиктором неблагоприятных исходов (ИМ, сердечная недостаточность, внезапная сердечная смерть в период в среднем до 6,3 лет).…”

“…Допплеровский метод исследования является уголзависимым. Однако, несмотря на использование только абсолютных величин скоростей коронарного кровотока, проспективно была показана жесткая связь с дальнейшими клиническими исходами [14]. Выводы 1.…”

Highlights from the International Journal of Cardiology Heart & Vasculature: Heart failure, atrial fibrillation, coronary artery disease and myocardial infarction

“…This clinical diagnostic score system may help to prescreen for coronary artery spasm in patients with acute chest pain. Additionally, several invasive and non-invasive strategies are currently used to assess the functional significance of coronary lesions [46], [47] and coronary CT angiography is a widely used strategy to detect significant coronary lesions non-invasively [48], [49].…”