Author + information
- Received January 17, 2019
- Revision received August 8, 2019
- Accepted August 12, 2019
- Published online October 28, 2019.
- Quirino Ciampi, MD, PhDa,
- Angela Zagatina, MD, PhDb,
- Lauro Cortigiani, MDc,
- Nicola Gaibazzi, MD, PhDd,
- Clarissa Borguezan Daros, MDe,
- Nadezhda Zhuravskaya, MDb,
- Karina Wierzbowska-Drabik, MD, PhDf,
- Jaroslaw D. Kasprzak, MD, PhDf,
- José Luis de Castro e Silva Pretto, MDg,
- Antonello D'Andrea, MD, PhDh,
- Ana Djordjevic-Dikic, MD, PhDi,
- Ines Monte, MDj,
- Iana Simova, MD, PhDk,
- Alla Boshchenko, MD, PhDl,
- Rodolfo Citro, MD, PhDm,
- Miguel Amor, MDn,
- Pablo Martin Merlo, MDo,
- Claudio Dodi, MDp,
- Fausto Rigo, MDq,
- Suzana Gligorova, MDr,
- Milica Dekleva, MDs,
- Sergio Severino, MDt,
- Fabio Lattanzi, MDu,
- Maria Chiara Scali, MD, PhDu,
- Alexander Vrublevsky, MDl,
- Marco A.R. Torres, MD, PhDv,
- Alessandro Salustri, MDw,
- Hugo Rodrìguez-Zanella, MDx,
- Fabio Marco Costantino, MDy,
- Albert Varga, MD, PhDz,
- Eduardo Bossone, MDaa,
- Paolo Colonna, MD, PhDbb,
- Michele De Nes, BSccc,
- Marco Paterni, BSccc,
- Clara Carpeggiani, MDcc,
- Jorge Lowenstein, MDo,
- Dario Gregori, PhDdd,
- Eugenio Picano, MD, PhDcc,∗ (, )@eupic58,
- on behalf of the Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging
- aCardiology Division, Fatebenefratelli Hospital, Benevento, Italy
- bCardiology Department, Saint Petersburg University Clinic, Saint Petersburg, Russian Federation
- cCardiology Department, San Luca Hospital, Lucca, Italy
- dCardiology Department, Parma University Hospital, Parma, Italy
- eCardiology Division, Hospital São José, Criciuma, Brazil
- fCardiology, Bieganski Hospital, Medical University, Lodz, Poland
- gHospital Sao Vicente de Paulo e Hospital de Cidade, Passo Fundo, Brazil
- hCardiology Department, Echocardiography Lab and Rehabilitation Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
- iCardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
- jCardio-Thorax-Vascular Department, Echocardiography Lab, “Policlinico Vittorio Emanuele,” Catania University, Catania, Italy
- kHead of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria
- lCardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
- mCardiology Department and Echocardiography Lab, University Hospital “San Giovanni di Dio e Ruggi d'Aragona,”, Salerno, Italy
- nCardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
- oCardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
- pCasa di Cura Figlie di San Camillo, Cremona, Italy
- qCardiology Department, Ospedale dell'Angelo Mestre-Venice, Venice, Italy
- rCardiology Division Ospedale Casilino, Roma, Italy
- sClinical Cardiology Department, Clinical Hospital Zvezdara, Medical School, University of Belgrade, Belgrade, Serbia
- tCardiology Department, Coronary Care Unit, Monaldi Hospital, Second University of Naples, Naples, Italy
- uCardiothoracic Department, University of Pisa, Pisa, Italy
- vHospital de Clinicas de Porto Alegre–Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- wNon-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- xInstituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico
- yCardiology Department, San Carlo Hospital, Potenza, Italy
- zInstitute of Family Medicine, University of Szeged, Szeged, Hungary
- aaAzienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy
- bbCardiology Hospital, Policlinico of Bari, Bari, Italy
- ccCNR, Institute of Clinical Physiology, Biomedicine Department, Pisa, Italy
- ddBiostatistics, Epidemiology and Public Health Unit, Padova University, Padova, Italy
- ↵∗Address for correspondence:
Dr. Eugenio Picano, CNR Research Campus-Institute Clinical Physiology, Building C- Room 130, Via Moruzzi, 1, 56124 Pisa, Italy.
Background The assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA).
Objectives The purpose of this study was to assess the feasibility and functional correlates of CFVR.
Methods This prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up.
Results The success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome.
Conclusions CFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.
- coronary artery disease
- coronary flow velocity reserve
- heart failure
- lung ultrasound
- stress echocardiography
Institutional funding for this study was provided by the CNR Institute of Clinical Physiology. Dr. Rodrìguez-Zanella has served on the Speakers Bureau of Siemens Healthineers. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 17, 2019.
- Revision received August 8, 2019.
- Accepted August 12, 2019.
- 2019 American College of Cardiology Foundation
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