European Journal of Echocardiography Advance Access originally published online on June 25, 2008
European Journal of Echocardiography 2009 10(1):127-132; doi:10.1093/ejechocard/jen190
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Prognostic value of transthoracic coronary flow reserve in medically treated patients with proximal left anterior descending artery stenosis of intermediate severity
1 Department of Cardiology and Intensive Care Unit, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200 Compiègne, France
2 INSERM, ERI 12, Department of Cardiology, Centre Hospitalier Universitaire d’ Amiens, France
Received 26 February 2008; accepted after revision 30 May 2008; online publish-ahead-of-print 25 June 2008.
* Corresponding author. Tel: +33 3 44 23 62 39; fax: +33 3 44 23 62 38. E-mail address: patrickmeimoun{at}free.fr; p.meimoun{at}ch-compiegne.fr
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Abstract |
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Aims: Prognostic value of transthoracic coronary flow reserve (T-CFR) is not established in patients with left anterior descending artery (LAD) stenosis of intermediate severity. Objective is to determine the prognosis value of T-CFR > 2 in medically treated patients with angiographically intermediate [50–70% QCA (quantitative coronary angiography)] proximal LAD stenosis.
Methods and results: Among 110 consecutive patients with intermediate LAD stenosis who underwent prospectively T-CFR in the distal part of the LAD after intravenous administration of adenosine to assess the functional significance of the stenosis, 80 patients had T-CFR > 2 and were treated medically without revascularization (Group 1). Among the 30 patients who had T-CFR < 2, an additional dobutamine stress echocardiography (DSE) was performed: 15 had a negative DSE; were treated medically and served as a comparative group (Group 2), and 15 had a positive DSE; underwent LAD revascularization, and were excluded from further analysis. All patients completed follow-up (16 ± 10 months). During the follow-up period (range 6–45 months), 76 patients (95%) remained free of death or LAD-related event in Group 1, vs. 12 patients (80%) in Group 2. By Kaplan–Meier method, at 30 months the per cent estimated survival free from death or target vessel-related events was 92 ± 4% in Group 1 and 44 ± 22% in Group 2 (P < 0.01). By multivariate analysis, T-CFR remained the only independent predictor of death or LAD-related events.
Conclusion: In patients with proximal LAD stenosis of intermediate severity and T-CFR > 2, deferral of revascularization is associated with low event rate.
Keywords: Coronary flow reserve; Transthoracic Doppler; Intermediate coronary stenosis; Left anterior descending artery