Abstract
Abstract OnBehalf Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging Background Stress echocardiography (SE) based on regional wall motion abnormalities (RWMA) has established risk stratification capabilities, further enhanced by assessment of coronary flow velocity reserve (CFVR) on mid-distal left anterior descending coronary artery which assesses not only epicardial coronary artery stenosis but also coronary microcirculation. Aim To assess the value of CFVR in predicting outcome Methods From September 2016 to December 2018, we enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 631, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. CFVR was measured from pulsed wave Doppler as peak/rest ratio of peak diastolic flow. All patients were followed-up for a median of 16 months. Results CFV was 28 ± 10 cm/s at rest and 62 ± 19 cm/s at peak stress (p<.001) with a CFVR of 2.25 ± 0.58. At individual patient analysis, CFVR was abnormal (≤2.0) in 528 (28%) patients: 265 (42%) with exercise, 254 (21%) with vasodilator and 9 (21%) with dobutamine stress. At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 acute heart failures, and 112 late (> 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced RWMA (Hazard Ratio 3.883, 95% Confidence Intervals: 2.379-6.336, p<.0.001) and CFVR (Hazard Ratio 1.590, 95% Confidence Intervals: 1.123-2.275, p<.009) were independent predictors. Kaplan-Meier curves showed progressively worsening event-free survival with progressively lower values of CFVR: see figure Conclusion In patients referred to SE, CFVR assessing coronary microvascular dysfunction allows a more accurate prediction of outcome than RWMA which only detect epicardial coronary artery stenoses. Abstract P1792 Figure. CFVR and event-free survival curves
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