Incremental Value of Transthoracic Doppler Echocardiography‐Assessed Coronary Flow Reserve in Patients With Suspected Myocardial Ischemia Undergoing Myocardial Perfusion Scintigraphy

Abstract

BackgroundAdenosine‐assisted transthoracic Doppler‐derived coronary flow reserve (TDE‐CFR) reflects coronary vascular function. The prognostic and incremental value of left anterior descending coronary artery TDE‐CFR above myocardial perfusion scintigraphy in patients with suspected myocardial ischemia has not yet been studied.Methods and ResultsThree hundred seventy‐one patients (mean age, 62.3±8.7 years; 46.8% males) referred to myocardial perfusion scintigraphy attributed to suspected myocardial ischemia were included in the study. The TDE‐CFR result was blinded to the referring physician. Patients were followed up regarding major cardiovascular events, defined as cardiovascular death, myocardial infarction, or acute revascularization during a median follow‐up time of 4.5 years. A TDE‐CFR value of ≤2.0 was considered reduced. Major cardiovascular events occurred during follow‐up in 60 patients (16.2%). A reduced TDE‐CFR was detected in 76 patients (20.5%). Patients with reduced TDE‐CFR had an event rate of 36.8% compared to 10.8% in patients with normal TDE‐CFR (unadjusted hazard ratio, 4.63; 95% CI, 2.78–7.69; P<0.001). In a multivariate model, TDE‐CFR remained a significant independent predictor of major cardiovascular events. The major cardiovascular events rate was 7.5% in patients without myocardial perfusion scintigraphy‐detected myocardial ischemia and normal TDE‐CFR (n=200), 24.2% in patients without ischemia but with reduced TDE‐CFR (n=33), and 46.5% in patients with both myocardial perfusion scintigraphy–detected myocardial ischemia and a reduced TDE‐CFR (n=43; P<0.001).ConclusionsCoronary microvascular dysfunction, as determined by TDE‐CFR, is a strong independent predictor of cardiovascular events and adds incremental prognostic value compared with myocardial perfusion scintigraphy. The current study supports routine assessment of CFR in patients with suspected ischemic heart disease.

Patients with moderate chronic kidney disease without heart disease have reduced coronary flow velocity reserve

“…It has been suggested that coronary microvascular dysfunction (CMD) might be important in the pathogenesis of HFpEF 13 . Interestingly, coronary microvascular function can be assessed non‐invasively by measuring coronary flow velocity reserve (CFVR) by Doppler echocardiography 14 . We hypothesized that CKD patients without symptomatic heart disease could have CMD and that this abnormality might contribute to the development of HFpEF.…”

New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation

“…CFR is a composite measure of coronary macrovascular and microvascular status. A reduced CFR is associated to a negative prognosis in several groups of patients, including those with diabetes mellitus, arterial hypertension, ischemic cardiomyopathy, normal coronaries, and CAD [ 47 ]. In patients with IHD, CFR is related to angiographic findings and it is a predictor of the extent and severity of CAD [ 48 ].…”

Does celiac disease impair coronary microvascular circulation: Coronary flow velocity reserve of patients with celiac disease

“…[15][16][17] Coronary flow velocity reserve (CFVR) is the ratio of hyperemic to rest myocardial blood flow, and it can provide a combined physiological measurement of macrovascular and microvascular ischemia. [18][19][20][21][22][23] Reduced CFVR is reported to convey prognostic information on cardiovascular outcomes in different diseases. 18 Transthoracic Doppler echocardiography (TTDE) for assessment of CFVR is a validated, reproducible method to assess CFVR, and it is suggested by the European Society of Cardiology.…”

“…18 Transthoracic Doppler echocardiography (TTDE) for assessment of CFVR is a validated, reproducible method to assess CFVR, and it is suggested by the European Society of Cardiology. [18][19][20][21][22][23] Reduced CFVR is reported to convey prognostic information on cardiovascular outcomes in different diseases. 18 C-reactive protein and albumin are inflammatory markers, and they are associated with atherosclerotic disease and CAD.…”