Abstract
BackgroundCoronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the LAD is used to assess microvascular function but validation studies in clinical settings are lacking. We aimed to assess feasibility, reproducibility and agreement with myocardial flow reserve (MFR) measured by PET in overweight and obese patients.MethodsParticipants with revascularized coronary artery disease were examined by CFVR. Subgroups were examined by repeated CFVR (reproducibility) or Rubidium-82-PET (agreement). To account for time variation, results were computed for scans performed within a week (1-week) and for all scans regardless of time gap (total) and to account for scar tissue for patients with and without previous myocardial infarction (MI).ResultsEighty-six patients with median BMI 30.9 (IQR 29.4–32.9) kg × m−2 and CFVR 2.29 (1.90–2.63) were included. CFVR was feasible in 83 (97 %) using a contrast agent in 14 %. For reproducibility overall (n = 21) limits of agreement (LOA) were (−0.75;0.71), within-subjects coefficient of variation (CV) 11 %, and reliability 0.84. For reproducibility within 1-week (n = 13) LOA were (−0.33;0.25), within-subjects CV 5 %, and reliability 0.97. Agreement with MFR of the LAD territory (n = 35) was without significant bias and overall LOA were (−1.40;1.46). Agreement was best for examinations performed within 1-week of participants without MI of the LAD-territory (n = 12); LOA = (−0.68;0.88).ConclusionsCFVR was highly feasible with a good reproducibility on par with other contemporary measures applied in cardiology. Agreement with MFR was acceptable, though discrepancy related to prior MI has to be considered. CFVR of LAD is a valid tool in overweight and obese patients.
Highlights
Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the left anterior descending coronary artery (LAD) is used to assess microvascular function but validation studies in clinical settings are lacking
For the study on agreement with myocardial flow reserve (MFR), thirty-nine participants underwent positron emission tomography (PET) imaging; of them two were excluded from the analysis due to technical errors resulting in too few counts during the stress part of the examination, and in two CFVR was not feasible
We have previously reported inter and intra-observer variability of repeated off-line Coronary flow reserve (CFR) readings with within-subject coefficient of variation (CV) and limits of agreement (LOA) of 5.5 % and ±0.21 (n = 39), and 7.5 % and ±0.29 (n = 10), respectively [24]
Summary
Coronary flow velocity reserve (CFVR) measured by transthoracic Doppler echocardiography of the LAD is used to assess microvascular function but validation studies in clinical settings are lacking. In absence of significant coronary artery stenosis, CFR is considered a quantitative measure of coronary microvascular function [2]. Coronary microvascular function is increasingly being recognised as an important pathophysiologic and prognostic factor in cardiovascular disorders [2, 4]. Coronary flow velocity reserve (CFVR) measured by transthoracic echocardiography (TTE) with spectral Doppler measurement of coronary artery flow velocity (CFV) is a non-invasive, non-ionising method and the least expensive for measurement of coronary microvascular function. CFVR has both diagnostic and prognostic implications and may be a useful translational tool for risk-stratification and to evaluate potential effects of intervention both in preclinical and clinical proof-of-concept studies [3, 6,7,8,9,10]
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