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Diagnostic and prognostic value of Doppler echocardiographic coronary flow reserve on left anterior descending artery in hypertensive and normotensive patients
  1. Lauro Cortigiani1,
  2. Fausto Rigo2,
  3. Maurizio Galderisi3,
  4. Sonia Gherardi4,
  5. Francesco Bovenzi1,
  6. Eugenio Picano5,
  7. Rosa Sicari5
  1. 1Cardiology Division, Campo di Marte Hospital, Lucca, Italy
  2. 2Cardiology Division, Umberto I Hospital, Mestre-Venice, Italy
  3. 3Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
  4. 4Cardiology Division, Cesena Hospital, Italy
  5. 5CNR, Institute of Clinical Physiology, Pisa, Italy
  1. Correspondence to Dr Rosa Sicari, CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy; rosas{at}ifc.cnr.it

Abstract

Background Vasodilator stress echocardiography allows dual imaging of regional wall motion and coronary flow reserve (CFR) on left anterior descending (LAD) artery. Hypertension may affect CFR independently of obstructive coronary artery disease (CAD) through coronary microcirculatory damage.

Aims The authors sought to determine the best value of Doppler-echocardiography-derived coronary flow reserve (CFR) for detecting ≥75% stenosis of the left anterior descending artery (LAD) and assessing the risk in patients with and without hypertension.

Participants The study group was formed by 2089 patients (1411 hypertensive patients and 678 normotensive patients) with known or suspected coronary artery disease who underwent dipyridamole (up to 0.84 mg/kg over 6 min) stress echo with CFR assessment of LAD by Doppler and coronary angiography.

Results Mean CFR was 2.20±0.62 in hypertensive patients and 2.36±0.70 in normotensive patients (p<0.0001). A significant LAD stenosis was present in 376 (18%) cases. With a receiver operating characteristic analysis, a CFR ≤1.91 was the best value for diagnosing LAD stenosis in both hypertensive patients (area under curve 0.86 (95% CI 0.84 to 0.88), sensitivity 87% (95% CI 82% to 91%), specificity 76% (95% CI 73% to 78%)) and normotensive patients (area under curve 0.90 (95% CI 0.88 to 0.92), sensitivity 89% (95% CI 81% to 95%), specificity 80% (95% CI 77% to 83%)). During a median follow-up of 15 months, there were 348 events (58 deaths, 79 ST elevation myocardial infarctions and 211 non-ST elevation myocardial infarctions). Multivariable prognostic indicators were age (HR=1.0; 95% CI 1.0 to 1.04), test positivity for wall motion criteria (HR=5.9; 95% CI 3.6 to 9.6) and CFR on LAD ≤1.91 (HR=3.4; CI 95% 2.0 to 5.6) in normotensive patients and previous myocardial infarction (HR=1.3; 95% CI 1.0 to 1.7), test positivity for wall motion criteria (HR=5.0; 95% CI 3.8 to 6.6) and CFR on LAD ≤1.91 (HR=3.1; CI 95% 2.4 to 4.1) in hypertensive patients.

Conclusions CFR on LAD provides useful information for vessel stenosis and prognostic assessment in both hypertensive and normotensive patients. However, diagnostic specificity is reduced in hypertensive.

  • Vasodilator stress testing
  • prognosis
  • hypertension
  • microvascular disease
  • coronary artery disease
  • imaging and diagnostics
  • echocardiography
  • stress
  • cardiac function
  • diastole
  • coronary flow reserve
  • clinical hypertension
  • coronary flow
  • Doppler ultrasound
  • heart failure
  • tissue Doppler
  • stress echocardiography
  • microvascular dysfunction
  • ultrasound
  • coronary heart disease
  • diagnostic imaging
  • exercise echocardiography
  • dobutamine echocardiography
  • prognosis
  • EBM
  • STEMI
  • stable angina
  • NSTEMI
  • mitral regurgitation
  • mitral stenosis
  • mitral valve prolapse
  • prosthetic heart valves
  • tricuspid valve disease
  • hypertension
  • imaging and diagnostics
  • coronary flow
  • stress

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Footnotes

  • The preliminary data were presented at the European Society of Cardiology Meeting, Barcelona, Spain, 30 August–3 September, 2009.

  • Funding Financial support for the present study was received from institutional funding of the CNR, Institute of Clinical Physiology, Pisa, Italy.

  • Competing interests None

  • Patient consent Obtained.

  • Ethics approval Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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