Key result
In patients with preserved LVEF, normal coronary flow velocity reserve obtained before achieving target heart rate was associated with a significantly lower rate of cardiovascular events compared to abnormal reserve (6.5% vs 46%, adjusted p=0.012).
Why the study?
Does normal coronary flow velocity reserve obtained before achieving target heart rate during dobutamine stress echocardiography predict better prognosis in patients with preserved LVEF?
Observational (n=83)
Yes
Does normal coronary flow velocity reserve obtained before achieving target heart rate during dobutamine stress echocardiography predict better prognosis in patients with preserved LVEF?
In patients with preserved LVEF undergoing dobutamine stress echocardiography, achieving a normal coronary flow velocity reserve before reaching target heart rate is associated with a better prognosis.
Normal pre-target HR CFVR was associated with fewer events in preserved LVEF; leaves open whether it refines DSE risk stratification.
BACKGROUND:: Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). OBJECTIVE:: To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR. METHODS:: Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events. RESULTS:: In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012). CONCLUSION:: In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis. FUNDAMENTO:: A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima). OBJETIVO:: Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina (EED) concluído, considerando a FC alvo submáxima. MÉTODOS:: studo prospectivo de pacientes com FEVE preservada e RVFC obtida na ADA durante EED concluído. No Grupo I (GI=31), a RVFC adequada foi obtida antes de se atingir a FC alvo, e no Grupo II (G II=28), após. O Grupo III (G III=24) atingiu a FC alvo, mas a RVFC foi inadequada. Foram considerados eventos: óbito, insuficiência coronariana aguda, intervenção coronariana, coronariografia sem intervenção subsequente e internamento hospitalar. RESULTADOS:: Em 28 ± 4 meses, ocorreram 18 (21,6%) eventos, sendo 6% (2/31) no GI, 18% (5/28) no GII e 46% (11/24) no GIII. Foram 4 (4,8%) óbitos, 6 (7,2%) intervenções coronarianas e 8 (9,6%) coronariografias sem intervenção subsequente. Na sobrevida livre de eventos pela análise de regressão, GIII apresentou mais eventos do que GI (p < 0,001) ou GII (p < 0,045), não havendo diferença entre GI e GII (p = 0,160). Após o ajustamento, foi mantida a diferença apenas entre GIII e GI (p = 0,012). CONCLUSÃO:: Em pacientes com FEVE preservada e EED concluído, a RVFC adequada obtida antes da FC alvo associou-se ao melhor prognóstico.
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Abreu et al. (2017) conducted an observational in Coronary Artery Disease (n=83). Normal early coronary flow velocity reserve (CFVR ≥ 2 obtained before target heart rate) vs. Abnormal CFVR or normal late CFVR was evaluated on Composite of cardiovascular death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization (p=0.012). In patients with preserved LVEF, normal coronary flow velocity reserve obtained before achieving target heart rate was associated with a significantly lower rate of cardiovascular events compared to abnormal reserve (6.5% vs 46%, adjusted p=0.012).
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