European Heart Journal Advance Access originally published online on December 6, 2007
European Heart Journal 2008 29(1):79-88; doi:10.1093/eurheartj/ehm527
The additive prognostic value of wall motion abnormalities and coronary flow reserve during dipyridamole stress echo
1 Cardiology Division, Umberto I° Hospital, Mestre-Venice, Italy
2 CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
3 Cardiology Division, Cesena Hospital, Italy
4 Institute for Cardiovascular Disease, Clinical Center of Serbia, Belgrade, Yugoslavia
5 Cardiology Division, Campo di Marte Hospital, Lucca, Italy
Received 15 March 2007; revised 18 October 2007; accepted 29 October 2007; online publish-ahead-of-print 6 December 2007.
* Corresponding author. Tel: +39 050 3152397, Fax: +39 050 3152216, Email: rosas{at}ifc.cnr.it
Aims: The aim of the study was to evaluate the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) over regional wall motion in patients with known or suspected coronary artery disease (CAD) undergoing dipyridamole echocardiography test (DET).
Methods and results: In a prospective, multicentre, observational study, we evaluated 1145 patients (702 males; 64 ± 11 years) who underwent high-dose dipyridamole (0.84 mg/kg over 6 min) stress echo with CFR evaluation of LAD by Doppler. DET was positive for regional wall motion abnormalities in 291 (25%) and negative in 854 (74%) patients. Mean CFR was 2.2 ± 0.5. At individual patient analysis 702 patients had normal (CFR > 2.0) and 443 had abnormal CFR on LAD. During a median follow-up of 27 months, 109 events occurred: 16 deaths, 17 non-fatal myocardial infarctions, 76 re-hospitalizations for unstable angina. The 30 months infarction-free survival showed the best outcome for those patients with negative DET by wall motion criteria and normal CFR and the worst outcome for patients with positive DET by wall motion and abnormal CFR (99 vs. 68%, P < 0.001). At multivariable analysis, CFR on LAD [hazard ratio (HR) 2.4, 95% CI 1.1–5.4, P = 0.030], medical therapy at time of testing (HR 2.8, 95% CI 1.2–6.6, P = 0.022), DET positivity for regional wall motion abnormalities (HR 3.6, 95% CI 1.5–8.7, P = 0.000), and angina on effort (HR 6.3, 95% CI 2.7–14.8, P = 0.000) were independent prognostic predictors of hard cardiac events.
Conclusion: In patients with known or suspected CAD, DET result by wall motion criteria and CFR are additive and complementary for the identification of patients at risk of experiencing hard events.
Key Words: Coronary flow reserve • Dipyridamole stress echocardiography • Prognosis
The preliminary data were presented at the American Heart Association Annual Meeting, Chicago, IL, USA, 14 November 2006.
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