Role of Coronary Flow Velocity in Predicting Adverse Outcome in Clinical Practice

Zagatina, Angela; Zhuravskaya, Nadezhda; Каменских, М. С.; Шматов, Д. В.; Sayganov, S. A.; Rigo, Fausto

doi:10.1016/j.ultrasmedbio.2018.03.021

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…In addition, some studies showed that Doppler echocardiographic-derived coronary flow velocity had prognostic value [10, 11]; however, due to anatomic factors and technological limitation (e.g., the application was confined to LAD), the noninvasive demonstration of coronary flow pattern (transthoracic Doppler echocardiography, TTDE) does not widely apply to the assessment of coronary flow, including the CSFP.…”

Section: Discussionmentioning

confidence: 99%

Clinical Profile and Outcome in Patients with Coronary Slow Flow Phenomenon

Zhu

Shen

Gao

et al. 2019

Cardiology Research and Practice

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The coronary slow flow phenomenon (CSFP) is a poorly recognized clinical entity characterized by delayed distal vessel opacification in the absence of epicardial coronary stenosis and presently lack of specific data on the clinical profile and outcome. We investigated a cohort of 429 patients who fulfilled the criteria for CSFP to explore the clinical feature, outcome, and risk factor of prognosis. Two teams (clinical center and core lab) were blind to patient data for the assessment of coronary angiograph using corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). The study cohort consisted of 429 patients (294 men, 68.5%), aged from 30 to 78 years (mean, 54 years). Two hundred patients (46.6%) out of 429 patients had a history of hypertension, 72 (16.8%) had diabetes mellitus, and 222 (51.7%) had dyslipidemia. All the rates of agreement between two teams in evaluating whether normal flow (CTFC ≤ 27 frames) or slow flow (CTFC > 27 frames) were moderate (0.40 < κ < 0.75) for the three arteries. Follow-up (mean, 3.8 years) was done for 421 patients (98.1%). The major adverse cardiovascular events (MACE) occurred in 39 patients (9.3%) out of 421 patients. Multivariate analysis showed that the risk of MACE approximately doubles with age >50 years (hazard ratio (HR) = 2.2, 95% CI: 1.0 to 4.9, and P=0.042), hypertension (HR = 2.1, 95% CI: 1.1 to 4.2, and P=0.021), and dyslipidemia (HR = 2.0, 95% CI: 1.0 to 3.9, and P=0.042). CSFP affects predominantly patients at middle age and above but can occur in any age group; CSFP should be more concerned, particularly in patients >50 years old with hypertension and dyslipidemia.

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Section: Discussionmentioning

confidence: 99%

Clinical Profile and Outcome in Patients with Coronary Slow Flow Phenomenon

Zhu

Shen

Gao

et al. 2019

Cardiology Research and Practice

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“…Усовершенствование ультразвукового оборудования за последние 10 лет позволило качественно изменить возможность исследования магистральных коронарных артерий при помощи серийного трансторакального датчика при выполнении рутинной эхокардиографии [3][4][5]. Проводились работы по сопоставлению данных ультразвукового исследования коронарных артерий с результатами коронароангиографии, в которых была доказана значимая корреляция между высокими скоростями коронарного кровотока и наличием значительных стенозов коронарных артерий, выявленных при проведении коронароангиографии [6,13].…”

Section: Discussionunclassified

“…Современные работы, посвященные исследованию коронарных артерий с помощью трансторакальной эхокардиографии, показывают, что визуализация и оценка кровотока в различных артериях сердца возможна у большинства пациентов, при этом в 97% случаев успех визуализации наблюдается при исследовании передней межжелудочковой артерии во всех сегментах с помощью серийного мультичастотного датчика [3][4][5]. В ряде недавних исследований показано значимое соответствие между высокими скоростями коронарного кровотока, измеренными по допплеровской эхокардиографии, и значимыми стенозами, диагно-стированными с помощью коронарной ангиографии [6,7]. Также подтверждена связь скоростных показателей коронарного кровотока с развитием неблагоприятных сердечно-сосудистых событий, когда в течение всего 10 мес.…”

Section: Introductionunclassified

“…Также подтверждена связь скоростных показателей коронарного кровотока с развитием неблагоприятных сердечно-сосудистых событий, когда в течение всего 10 мес. наблюдения смертность у пациентов с высокими скоростями в проксимальных отделах коронарных артерий достигает 6,4%, а острые коронарные события случаются у 10% пациентов [6]. Однако остается неясным влияние на прогноз реваскуляризации миокарда у пациентов с высокими скоростями коронарного кровотока.…”

Section: Introductionunclassified

“…Однако остается неясным влияние на прогноз реваскуляризации миокарда у пациентов с высокими скоростями коронарного кровотока. Данное исследование является субанализом ранее проведенного прогностического исследования [6].…”

Section: Introductionunclassified

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

Каменских

Zagatina

Zhuravskaya

et al. 2019

SMJ

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Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

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