Document Detail


Prognostic value of coronary flow reserve in medically treated patients with left anterior descending coronary disease with stenosis 51% to 75% in diameter.
MedLine Citation:
PMID:  17996513     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
According to American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions 2005 guidelines on percutaneous intervention, intracoronary physiologic measurement in the assessment of effects of intermediate coronary stenoses in patients with anginal symptoms is a class IIa indication. This study assessed the additional prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in patients with single-vessel disease and intermediate stenosis severity. We enrolled 86 patients (44 men; 66 +/- 10 years of age) with angiographically assessed single-vessel coronary artery disease of the left anterior descending coronary artery (LAD) with quantitatively assessed diameter stenosis severity 50% to 75%. All patients underwent dipyridamole (up to 0.84 mg/kg over 6 minutes) stress echocardiography with wall motion analysis by 2-dimensional echocardiography and CFR evaluation of the affected artery by Doppler. All patients were followed up for a median of 14 months (first quartile 10, third quartile 18) after diagnostic coronary angiography (without percutaneous intervention for a clinically driven decision). Mean diameter stenosis of the LAD was 58 +/- 10%. Mean CFR of the LAD was 2.09 +/- 0.5. Regional wall motion abnormality at peak stress was present in 17 patients. During follow-up, 24 events occurred: 6 nonfatal ST-elevation myocardial infarctions and 18 non-ST-elevation myocardial infarctions. Thirty-month spontaneous event-free survival was higher in patients with normal CFR and lower in patients with decreased CFR (86% vs 30%, p = 0.0001). At Cox analysis, a CFR <2 (hazard ratio 24.2, 95% confidence interval 3.2 to 179.7, p = 0.002) was the only independent prognostic predictor of outcome. In conclusion, in medically treated patients with single-vessel disease of intermediate severity, decreased CFR is associated with a worse outcome.
Authors:
Fausto Rigo; Rosa Sicari; Sonia Gherardi; Ana Djordjevic-Dikic; Lauro Cortigiani; Eugenio Picano
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2007-09-27
Journal Detail:
Title:  The American journal of cardiology     Volume:  100     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-11-12     Completed Date:  2008-01-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1527-31     Citation Subset:  AIM; IM    
Affiliation:
Cardiology Division, Umberto Io Hospital, Mestre-Venice, Italy.
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Aged
Calcium Channel Blockers / therapeutic use
Coronary Artery Disease / drug therapy,  physiopathology*
Coronary Circulation / physiology*
Coronary Stenosis / physiopathology,  ultrasonography*
Dipyridamole
Echocardiography, Doppler
Echocardiography, Stress
Female
Follow-Up Studies
Humans
Male
Myocardial Infarction / epidemiology,  physiopathology
Nitrates / therapeutic use
Outcome Assessment (Health Care)*
Prognosis
Prospective Studies
Severity of Illness Index
Vasodilator Agents
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Calcium Channel Blockers; 0/Nitrates; 0/Vasodilator Agents; 58-32-2/Dipyridamole

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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