Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease

Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease

Abstract Background Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of...

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Veröffentlicht in:European heart journal 2024-10, Vol.45 (Supplement_1)
Hauptverfasser: Cerracchio, E, Cortigiani, L, Gaibazzi, N, Ciampi, Q, Tuttolomondo, D, Navacchi, R, Bovenzi, F, Carerj, S, Pepi, M, Pellikka, P A, Picano, E
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container_title European heart journal
container_volume 45
creator Cerracchio, E
Cortigiani, L
Gaibazzi, N
Ciampi, Q
Tuttolomondo, D
Navacchi, R
Bovenzi, F
Carerj, S
Pepi, M
Pellikka, P A
Picano, E
description Abstract Background Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery. Purpose To assess the value of SE with RWMA and CFVR to predict survival in PAD. Methods In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69±8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value
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Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery. Purpose To assess the value of SE with RWMA and CFVR to predict survival in PAD. Methods In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69±8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value &lt;2.0). All patients were followed up for a median of 4.7 (interquartile range: 2.0 to 8.2 years). All-cause death was the outcome end-point. Results The positivity rate was 37/359 (10%) for RWMA and 159/359 (44%) for CFVR. During follow-up, 97 (27%) deaths were registered. At multivariable analysis, inducible RWMA and/or CFVR &lt;2.0 (HR 2.58, 95% CI 1.65-4.04; p&lt;0.0001), age ≥70 years, diabetes, dialysis treatment, and ejection fraction ≤50% were associated with decreased survival. The annual mortality was 7.4% in patients with RWMA and/or CFVR &lt;2.0 and 2.7% in those with no RWMA and CFVR &gt;2.0 (Figure, p&lt;0.0001). Conclusion In patients with PAD, SE shows more than 4-fold higher prevalence of abnormal CFVR compared to RWMA. The prognostic value of CFVR outperforms RWMA, showing the importance of coronary microvascular dysfunction and diffuse, subcritical coronary atherosclerosis in determining the outcome.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehae666.061</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2024-10, Vol.45 (Supplement_1)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Cerracchio, E</creatorcontrib><creatorcontrib>Cortigiani, L</creatorcontrib><creatorcontrib>Gaibazzi, N</creatorcontrib><creatorcontrib>Ciampi, Q</creatorcontrib><creatorcontrib>Tuttolomondo, D</creatorcontrib><creatorcontrib>Navacchi, R</creatorcontrib><creatorcontrib>Bovenzi, F</creatorcontrib><creatorcontrib>Carerj, S</creatorcontrib><creatorcontrib>Pepi, M</creatorcontrib><creatorcontrib>Pellikka, P A</creatorcontrib><creatorcontrib>Picano, E</creatorcontrib><title>Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease</title><title>European heart journal</title><description>Abstract Background Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery. Purpose To assess the value of SE with RWMA and CFVR to predict survival in PAD. Methods In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69±8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value &lt;2.0). All patients were followed up for a median of 4.7 (interquartile range: 2.0 to 8.2 years). All-cause death was the outcome end-point. Results The positivity rate was 37/359 (10%) for RWMA and 159/359 (44%) for CFVR. During follow-up, 97 (27%) deaths were registered. At multivariable analysis, inducible RWMA and/or CFVR &lt;2.0 (HR 2.58, 95% CI 1.65-4.04; p&lt;0.0001), age ≥70 years, diabetes, dialysis treatment, and ejection fraction ≤50% were associated with decreased survival. The annual mortality was 7.4% in patients with RWMA and/or CFVR &lt;2.0 and 2.7% in those with no RWMA and CFVR &gt;2.0 (Figure, p&lt;0.0001). Conclusion In patients with PAD, SE shows more than 4-fold higher prevalence of abnormal CFVR compared to RWMA. The prognostic value of CFVR outperforms RWMA, showing the importance of coronary microvascular dysfunction and diffuse, subcritical coronary atherosclerosis in determining the outcome.</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNkMtqwzAQRUVpoWnaTyjoB5yM7EiWliX0BYF2kUV3RpFnYgXXMpKTkL-vS0LXXc3M4gz3HsYeBcwEmGKO-9igjcNujo1FpdQMlLhiEyHzPDNqIa_ZBISRmVL665bdpbQDAK2EmjD6jGHbhTR4x5Pfdp68s51DHoi7EENn44lTG478gG1wfjjxiAnjAbnveG8Hj92Q-NEPDe8x-r7BaFs-phmPcal9Qpvwnt2QbRM-XOaUrV-e18u3bPXx-r58WmVOlyJTZVGgLTfkJIEoyYCmGo0sSckaa6NsvgBZFGAMoNO5c7ldEDipQWlNm2LK5PmtiyGliFT10X-PFSoB1a-r6s9VdXFVja5GDs5c2Pf_RH4A4Bx1Hw</recordid><startdate>20241028</startdate><enddate>20241028</enddate><creator>Cerracchio, E</creator><creator>Cortigiani, L</creator><creator>Gaibazzi, N</creator><creator>Ciampi, Q</creator><creator>Tuttolomondo, D</creator><creator>Navacchi, R</creator><creator>Bovenzi, F</creator><creator>Carerj, S</creator><creator>Pepi, M</creator><creator>Pellikka, P A</creator><creator>Picano, E</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20241028</creationdate><title>Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease</title><author>Cerracchio, E ; Cortigiani, L ; Gaibazzi, N ; Ciampi, Q ; Tuttolomondo, D ; Navacchi, R ; Bovenzi, F ; Carerj, S ; Pepi, M ; Pellikka, P A ; Picano, E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c871-6733ea7bfc5f017f908fde957f65ded96a2405330990ec82cc2a4f0c580688fb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cerracchio, E</creatorcontrib><creatorcontrib>Cortigiani, L</creatorcontrib><creatorcontrib>Gaibazzi, N</creatorcontrib><creatorcontrib>Ciampi, Q</creatorcontrib><creatorcontrib>Tuttolomondo, D</creatorcontrib><creatorcontrib>Navacchi, R</creatorcontrib><creatorcontrib>Bovenzi, F</creatorcontrib><creatorcontrib>Carerj, S</creatorcontrib><creatorcontrib>Pepi, M</creatorcontrib><creatorcontrib>Pellikka, P A</creatorcontrib><creatorcontrib>Picano, E</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cerracchio, E</au><au>Cortigiani, L</au><au>Gaibazzi, N</au><au>Ciampi, Q</au><au>Tuttolomondo, D</au><au>Navacchi, R</au><au>Bovenzi, F</au><au>Carerj, S</au><au>Pepi, M</au><au>Pellikka, P A</au><au>Picano, E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease</atitle><jtitle>European heart journal</jtitle><date>2024-10-28</date><risdate>2024</risdate><volume>45</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract Background Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery. Purpose To assess the value of SE with RWMA and CFVR to predict survival in PAD. Methods In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69±8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value &lt;2.0). All patients were followed up for a median of 4.7 (interquartile range: 2.0 to 8.2 years). All-cause death was the outcome end-point. Results The positivity rate was 37/359 (10%) for RWMA and 159/359 (44%) for CFVR. During follow-up, 97 (27%) deaths were registered. At multivariable analysis, inducible RWMA and/or CFVR &lt;2.0 (HR 2.58, 95% CI 1.65-4.04; p&lt;0.0001), age ≥70 years, diabetes, dialysis treatment, and ejection fraction ≤50% were associated with decreased survival. The annual mortality was 7.4% in patients with RWMA and/or CFVR &lt;2.0 and 2.7% in those with no RWMA and CFVR &gt;2.0 (Figure, p&lt;0.0001). Conclusion In patients with PAD, SE shows more than 4-fold higher prevalence of abnormal CFVR compared to RWMA. The prognostic value of CFVR outperforms RWMA, showing the importance of coronary microvascular dysfunction and diffuse, subcritical coronary atherosclerosis in determining the outcome.</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehae666.061</doi></addata></record>
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title Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease
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