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Prognostic Correlates of Combined Coronary Flow Reserve Assessment on Left Anterior Descending and Right Coronary Artery in Patients with Negative Stress Echocardiography by Wall Motion Criteria
  1. Lauro Cortigiani MD (lacortig{at}
  1. Cardiology Division, Campo di Marte Hospital, Lucca, Italy
    1. Fausto Rigo
    1. Cardiology Division, Umberto I° Hospital, Mestre, Italy
      1. Rosa Sicari (rosas{at}
      1. CNR, Institute of Clinical Physiology, Pisa, Italy
        1. Sonia Gherardi (soniagherardi{at}
        1. Cardiology Division, Cesena Hospital, Italy
          1. Francesco Bovenzi
          1. Cardiology Division, Campo di Marte Hospital, Lucca, Italy
            1. Eugenio Picano (picano{at}
            1. CNR, Institute of Clinical Physiology, Pisa, Italy


              Aims: To assess the prognostic correlates of Doppler echocardiographic derived CFR on 2 coronaries in patients with negative stress echo.

              Methods and results: The study group comprised 460 patients with known or suspected coronary artery disease and negative stress echo by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6') stress echo with CFR evaluation of either LAD and RCA by Doppler, and were followed-up for a median of 32 months. A value of CFR ≤2.0 was taken as abnormal.

              CFR was abnormal in 174 patients (38%) (57 in LAD only, 48 in RCA only, and 69 in both LAD and RCA) and normal in 286 patients (62%). During follow-up, there were 77 cardiac events: 5 deaths, 44 acute coronary syndromes (6 STEMI, and 38 NSTEMI), and 28 late (>6 months from stress echo) revascularizations. CFR ≤2.0 on LAD was the strongest multivariable predictor of either hard (death, acute coronary syndrome) and major (death, acute coronary syndrome, late revascularization) events, followed by diabetes mellitus. Antischemic therapy at the time of testing and resting wall motion abnormality were also independently associated with major events. Preserved CFR in both LAD and RCA was associated with better (p<0.0001) hard and major event-free survival as compared to abnormal CFR in one or both coronary territories.

              Conclusion: CFR evaluation of either LAD and RCA allows identifying distinct prognostic patterns. In particular, preserved CFR in both coronary territories is highly predictive of very favourable outcome, while reduced CFR in either one coronary, and especially on LAD, is a strong predictor of future events.

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