European Heart Journal Advance Access originally published online on October 9, 2006
European Heart Journal 2006 27(21):2607-2608; doi:10.1093/eurheartj/ehl289
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Prognostic role of combination of coronary flow reserve with aortic distensibility indices
2nd Department of Medicine and Cardiology Centre
Medical Faculty
Albert Szent-Györgyi Medical and Pharmaceutical Center
University of Szeged
H-6720 Szeged Korányi fasor 6 PO Box 427
Hungary
Tel.: +36 62 545220
Fax: +36 62 544568
E-mail address: nemes{at}in2nd.szote.u-szeged.hu
Department of Cardiology
Thoraxcentre
Erasmus MC
Rotterdam The Netherlands
Department of Cardiology
Thoraxcentre
Erasmus MC
Rotterdam The Netherlands
Department of Cardiology
Thoraxcentre
Erasmus MC
Rotterdam The Netherlands
Department of Cardiology
Thoraxcentre
Erasmus MC
Rotterdam The Netherlands
We read with great interest the study of Rigo et al.1 entitled ‘The prognostic impact of coronary flow reserve assessed by Doppler echocardiography in non-ischaemic dilated cardiomyopathy’. This intriguing echocardiographic study found that Doppler echocardiographic-derived reduced coronary flow reserve (CFR) during vasodilator stress is an independent prognostic marker of bad prognosis in dilated cardiomyopathy (DCM). However, we feel that a few additional comments are necessary.
In recent studies, it has been demonstrated that higher NYHA functional class, lower ejection fraction, and increased left ventricular volumes are associated with a reduced CFR. Increased aortic stiffness has also been described in clinical patients with heart failure in ischaemic cardiomyopathy and DCM. The prognostic roles of CFR (as a characteristic of left anterior descending coronary artery vasoreactivity) and aortic distensibility alone have been widely investigated and confirmed.
In recent echocardiographic studies, we simultaneously investigated CFR and aortic distensibility indices [elastic modulus E(p) and Young's circumferential static elastic modulus E(s)] in patients with suspected or known coronary artery disease (CAD) during transoesophageal echocardiography. Alterations were found in CFR, E(p), and E(s) in CAD2 and in patients with normal epicardial coronary arteries with significant aortic valve stenosis,3 diabetes mellitus,4 hypercholesterolaemia,5 and hypertension.6 These simultaneously evaluated functional parameters [CFR, E(p), E(s)] showed correlations to the grade of aortic atherosclerosis, as well.7 Theoretically, it could be hypothesized that combined use of two strong prognostic predictors (CFR and aortic distensibility) of cardiovascular mortality can more reliably predict future events. Our preliminary follow-up data suggest that combination of CFR and aortic elastic properties [E(p) or E(s)] have a more detailed prognostic role on cardiovascular mortality than CFR alone. However, further investigations are warranted, especially with stress transthoracic echocardiography, in selected group of patients with DCM.
References
- Rigo F, Gherardi S, Galderisi M, Pratali L, Cortigiani L, Sicari R, Picano E. (2006) The prognostic impact of coronary flow-reserve assessed by Doppler echocardiography in non-ischaemic dilated cardiomyopathy. Eur Heart J 27:1319–1323.
[Abstract/Free Full Text] - Nemes A, Forster T, Gruber N, Csanady M. (2004) Coronary flow velocity reserve and indices describing aortic distensibility in patients after coronary angiography. Int J Cardiol 96:29–33.[CrossRef][Web of Science][Medline]
- Nemes A, Forster T, Csanady M. (2004) Decreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries. J Heart Valve Dis 13:567–573.[Web of Science][Medline]
- Nemes A, Forster T, Csanady M. (2006) Reduced aortic distensibility and coronary flow velocity reserve in diabetes mellitus patients with a negative coronary angiogram. Can J Cardiol in press.
- Nemes A, Forster T, Csanady M. (2006) Impaired coronary flow velocity reserve and aortic distensibility in patients with untreated hypercholesterolemia—an echocardiographic study. Int J Cardiovasc Imaging in press.
- Nemes A, Forster T, Csanady M. (2006) Simultaneous evaluation of coronary flow velocity reserve and aortic distensibility indices in hypertension. Heart Vessels in press.
- Nemes A, Forster T, Csanady M, Gruber N. (2004) Indices of aortic distensibility and coronary flow velocity reserve in patients with different grades of aortic atherosclerosis. Int J Cardiovasc Imaging 20:271–277.[CrossRef][Web of Science][Medline]
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  A. Nemes Relationship between coronary microcirculatory function and aortic stiffness in diabetes. J. Am. Coll. Cardiol., February 5, 2008; 51(5): 597 - 598. [Full Text] [PDF]
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