Coronary Flow Velocity Reserve during Pharmacologic Stress Echocardiography with Normal Contractility Adds Important Prognostic Value in Diabetic and Nondiabetic Patients

Lowenstein, Jorge; Caniggia, Cristian; Rousse, Graciela; Amor, Miguel; Sánchez, María Elena Díaz; Alasia, Diego; Casso, Norberto; García, Ana; Zambrana, Gustavo; Haber, Diego M. Lowenstein; Darú, Víctor

doi:10.1016/j.echo.2014.05.009

Cited by 43 publications

(25 citation statements)

References 29 publications

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“…10). In diabetic patients, a normal CFR is associated with tighter glycemic control [153] and better long-term event-free survival both considering unselected patients [146, 154] and patients with angiographically normal coronary arteries [151] (Fig. 9).…”

Section: Coronary Flow Reservementioning

confidence: 99%

The clinical use of stress echocardiography in ischemic heart disease

Sicari

Cortigiani²

2017

Cardiovasc Ultrasound

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Stress echocardiography is an established technique for the assessment of extent and severity of coronary artery disease. The combination of echocardiography with a physical, pharmacological or electrical stress allows to detect myocardial ischemia with an excellent accuracy. A transient worsening of regional function during stress is the hallmark of inducible ischemia. Stress echocardiography provides similar diagnostic and prognostic accuracy as radionuclide stress perfusion imaging or magnetic resonance, but at a substantially lower cost, without environmental impact, and with no biohazards for the patient and the physician.The evidence on its clinical impact has been collected over 35 years, based on solid experimental, pathophysiological, technological and clinical foundations. There is the need to implement the combination of wall motion and coronary flow reserve, assessed in the left anterior descending artery, into a single test. The improvement of technology and in imaging quality will make this approach more and more feasible. The future issues in stress echo will be the possibility of obtaining quantitative information translating the current qualitative assessment of regional wall motion into a number. The next challenge for stress echocardiography is to overcome its main weaknesses: dependance on operator expertise, the lack of outcome data (a widesperad problem in clinical imaging) to document the improvement of patient outcomes. This paper summarizes the main indications for the clinical applications of stress echocardiography to ischemic heart disease.

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Section: Coronary Flow Reservementioning

confidence: 99%

The clinical use of stress echocardiography in ischemic heart disease

Sicari

Cortigiani²

2017

Cardiovasc Ultrasound

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“…Those results support the measurement of CFVR during pharmacologic stress echocardiography, favoring its incorporation into routine practice. 10,12-15,25,26 …”

Section: Discussionmentioning

confidence: 99%

“…Because dobutamine is one of the most used drugs in stress echocardiography, it is worth noting the possibility of, in the same exam, having a consistent positive inotropic effect on the cardiac muscle and a proper coronary vasodilating effect to calculate CFVR. 6,12,13,15,20,21,27 …”

Section: Discussionmentioning

confidence: 99%

“…However, regardless of which component (micro- or macrovascular) is more important, both can be related to worse prognosis. 10,12-15,25,27 …”

Section: Discussionmentioning

confidence: 99%

“…6,10-12,16-20 When CFVR values are higher at the early stages of DSE, the exam is expected to be completed with no contractile abnormality compatible with myocardial ischemia. 21 However, a low CFVR value at the early stages of DSE can anticipate the occurrence of myocardial ischemia manifest as contractile abnormality.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate

Abreu¹,

Rocha²,

Machado³

et al. 2017

Arquivos Brasileiros De Cardiologia

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BackgroundNormal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR).ObjectiveTo evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR.MethodsProspective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events.ResultsIn 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012).ConclusionIn patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis.

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Dobutamine Stress Echocardiography

Camarozano,

Picano

2023

Stress Echocardiography

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Coronary Flow Velocity Reserve during Pharmacologic Stress Echocardiography with Normal Contractility Adds Important Prognostic Value in Diabetic and Nondiabetic Patients

Cited by 43 publications

References 29 publications

The clinical use of stress echocardiography in ischemic heart disease

The clinical use of stress echocardiography in ischemic heart disease

Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate

Dobutamine Stress Echocardiography

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