Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization
Coronary flow reserve (CFR), an integrated measure of focal, diffuse, and small-vessel coronary artery disease (CAD), identifies patients at risk for cardiac death. We sought to determine the association between CFR, angiographic CAD, and cardiovascular outcomes. Consecutive patients (n=329) referre...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2015-01, Vol.131 (1), p.19-27 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | Taqueti, Viviany R Hachamovitch, Rory Murthy, Venkatesh L Naya, Masanao Foster, Courtney R Hainer, Jon Dorbala, Sharmila Blankstein, Ron Di Carli, Marcelo F |
| description | Coronary flow reserve (CFR), an integrated measure of focal, diffuse, and small-vessel coronary artery disease (CAD), identifies patients at risk for cardiac death. We sought to determine the association between CFR, angiographic CAD, and cardiovascular outcomes.
Consecutive patients (n=329) referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography were followed (median 3.1 years) for cardiovascular death and heart failure admission. The extent and severity of angiographic disease were estimated with the use of the CAD prognostic index, and CFR was measured noninvasively by positron emission tomography. A modest inverse correlation was seen between CFR and CAD prognostic index (r=-0.26; P |
| doi_str_mv | 10.1161/CIRCULATIONAHA.114.011939 |
| format | Article |
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Consecutive patients (n=329) referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography were followed (median 3.1 years) for cardiovascular death and heart failure admission. The extent and severity of angiographic disease were estimated with the use of the CAD prognostic index, and CFR was measured noninvasively by positron emission tomography. A modest inverse correlation was seen between CFR and CAD prognostic index (r=-0.26; P<0.0001). After adjustment for clinical risk score, ejection fraction, global ischemia, and early revascularization, CFR and CAD prognostic index were independently associated with events (hazard ratio for unit decrease in CFR, 2.02; 95% confidence interval, 1.20-3.40; P=0.008; hazard ratio for 10-U increase in CAD prognostic index, 1.17; 95% confidence interval, 1.01-1.34; P=0.032). Subjects with low CFR experienced rates of events similar to those of subjects with high angiographic scores, and those with low CFR or high CAD prognostic index showed the highest risk of events (P=0.001). There was a significant interaction (P=0.039) between CFR and early revascularization by coronary artery bypass grafting, such that patients with low CFR who underwent coronary artery bypass grafting, but not percutaneous coronary intervention, experienced event rates comparable to those with preserved CFR, independently of revascularization.
CFR was associated with outcomes independently of angiographic CAD and modified the effect of early revascularization. Diffuse atherosclerosis and associated microvascular dysfunction may contribute to the pathophysiology of cardiovascular death and heart failure, and impact the outcomes of revascularization.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.114.011939</identifier><identifier>PMID: 25400060</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Cardiovascular Diseases - epidemiology ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease - physiopathology ; Coronary Artery Disease - therapy ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - physiopathology ; Death, Sudden, Cardiac - epidemiology ; Female ; Follow-Up Studies ; Fractional Flow Reserve, Myocardial - physiology ; Heart Failure - epidemiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction - epidemiology ; Percutaneous Coronary Intervention ; Positron-Emission Tomography ; Prognosis ; Regional Blood Flow - physiology ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2015-01, Vol.131 (1), p.19-27</ispartof><rights>2014 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c368t-21518ea9faf5cdafe995c179fb465e70551e0c5b342dafd32d28b0854e4ee2233</citedby><cites>FETCH-LOGICAL-c368t-21518ea9faf5cdafe995c179fb465e70551e0c5b342dafd32d28b0854e4ee2233</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25400060$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Taqueti, Viviany R</creatorcontrib><creatorcontrib>Hachamovitch, Rory</creatorcontrib><creatorcontrib>Murthy, Venkatesh L</creatorcontrib><creatorcontrib>Naya, Masanao</creatorcontrib><creatorcontrib>Foster, Courtney R</creatorcontrib><creatorcontrib>Hainer, Jon</creatorcontrib><creatorcontrib>Dorbala, Sharmila</creatorcontrib><creatorcontrib>Blankstein, Ron</creatorcontrib><creatorcontrib>Di Carli, Marcelo F</creatorcontrib><title>Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Coronary flow reserve (CFR), an integrated measure of focal, diffuse, and small-vessel coronary artery disease (CAD), identifies patients at risk for cardiac death. We sought to determine the association between CFR, angiographic CAD, and cardiovascular outcomes.
Consecutive patients (n=329) referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography were followed (median 3.1 years) for cardiovascular death and heart failure admission. The extent and severity of angiographic disease were estimated with the use of the CAD prognostic index, and CFR was measured noninvasively by positron emission tomography. A modest inverse correlation was seen between CFR and CAD prognostic index (r=-0.26; P<0.0001). After adjustment for clinical risk score, ejection fraction, global ischemia, and early revascularization, CFR and CAD prognostic index were independently associated with events (hazard ratio for unit decrease in CFR, 2.02; 95% confidence interval, 1.20-3.40; P=0.008; hazard ratio for 10-U increase in CAD prognostic index, 1.17; 95% confidence interval, 1.01-1.34; P=0.032). Subjects with low CFR experienced rates of events similar to those of subjects with high angiographic scores, and those with low CFR or high CAD prognostic index showed the highest risk of events (P=0.001). There was a significant interaction (P=0.039) between CFR and early revascularization by coronary artery bypass grafting, such that patients with low CFR who underwent coronary artery bypass grafting, but not percutaneous coronary intervention, experienced event rates comparable to those with preserved CFR, independently of revascularization.
CFR was associated with outcomes independently of angiographic CAD and modified the effect of early revascularization. Diffuse atherosclerosis and associated microvascular dysfunction may contribute to the pathophysiology of cardiovascular death and heart failure, and impact the outcomes of revascularization.</description><subject>Aged</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Coronary Angiography</subject><subject>Coronary Artery Bypass</subject><subject>Coronary Artery Disease - physiopathology</subject><subject>Coronary Artery Disease - therapy</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - physiopathology</subject><subject>Death, Sudden, Cardiac - epidemiology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Fractional Flow Reserve, Myocardial - physiology</subject><subject>Heart Failure - epidemiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Percutaneous Coronary Intervention</subject><subject>Positron-Emission Tomography</subject><subject>Prognosis</subject><subject>Regional Blood Flow - physiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>Treatment Outcome</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUV1rGzEQFKWlcdL-haK-9eVSfZ5Pj8a0icEkUJLnQyetYhXdyZV0Du6f6l-sjJNCX3bZ2ZlZ2EHoMyXXlLb063rzY_24XT1s7u9Wt6uKiWtCqeLqDVpQyUQjJFdv0YIQopolZ-wCXeb8s44tX8r36IJJcRrIAv25CXHQAZuY4qTTEbsQn3GCDOkA2Gesc47G6wIWP_uyw9oeIGXARifr40FnMwedMBxgKhn7ycIeaplKOOLocJhHP1V_PT35-JT0fucNzpWdfDlW1OIxWu88ZFx2gME5MOUkBJ2qQ4LXC_63Lj5OH9A7p0OGjy_9Cj1-__awvm229zeb9WrbGN52pWFU0g60ctpJY7UDpaShS-UG0UpYEikpECMHLljdWs4s6wbSSQECgDHOr9CXs-8-xV8z5NKPPhsIQU8Q59zTVnAqBOtOVHWmmhRzTuD6ffJj_WVPSX_Kq_8_r4qJ_pxX1X56OTMPI9h_yteA-F-uGZj3</recordid><startdate>20150106</startdate><enddate>20150106</enddate><creator>Taqueti, Viviany R</creator><creator>Hachamovitch, Rory</creator><creator>Murthy, Venkatesh L</creator><creator>Naya, Masanao</creator><creator>Foster, Courtney R</creator><creator>Hainer, Jon</creator><creator>Dorbala, Sharmila</creator><creator>Blankstein, Ron</creator><creator>Di Carli, Marcelo F</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150106</creationdate><title>Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization</title><author>Taqueti, Viviany R ; Hachamovitch, Rory ; Murthy, Venkatesh L ; Naya, Masanao ; Foster, Courtney R ; Hainer, Jon ; Dorbala, Sharmila ; Blankstein, Ron ; Di Carli, Marcelo F</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c368t-21518ea9faf5cdafe995c179fb465e70551e0c5b342dafd32d28b0854e4ee2233</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Coronary Angiography</topic><topic>Coronary Artery Bypass</topic><topic>Coronary Artery Disease - physiopathology</topic><topic>Coronary Artery Disease - therapy</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - physiopathology</topic><topic>Death, Sudden, Cardiac - epidemiology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Fractional Flow Reserve, Myocardial - physiology</topic><topic>Heart Failure - epidemiology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Percutaneous Coronary Intervention</topic><topic>Positron-Emission Tomography</topic><topic>Prognosis</topic><topic>Regional Blood Flow - physiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Taqueti, Viviany R</creatorcontrib><creatorcontrib>Hachamovitch, Rory</creatorcontrib><creatorcontrib>Murthy, Venkatesh L</creatorcontrib><creatorcontrib>Naya, Masanao</creatorcontrib><creatorcontrib>Foster, Courtney R</creatorcontrib><creatorcontrib>Hainer, Jon</creatorcontrib><creatorcontrib>Dorbala, Sharmila</creatorcontrib><creatorcontrib>Blankstein, Ron</creatorcontrib><creatorcontrib>Di Carli, Marcelo F</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Taqueti, Viviany R</au><au>Hachamovitch, Rory</au><au>Murthy, Venkatesh L</au><au>Naya, Masanao</au><au>Foster, Courtney R</au><au>Hainer, Jon</au><au>Dorbala, Sharmila</au><au>Blankstein, Ron</au><au>Di Carli, Marcelo F</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2015-01-06</date><risdate>2015</risdate><volume>131</volume><issue>1</issue><spage>19</spage><epage>27</epage><pages>19-27</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>Coronary flow reserve (CFR), an integrated measure of focal, diffuse, and small-vessel coronary artery disease (CAD), identifies patients at risk for cardiac death. We sought to determine the association between CFR, angiographic CAD, and cardiovascular outcomes.
Consecutive patients (n=329) referred for invasive coronary angiography after stress testing with myocardial perfusion positron emission tomography were followed (median 3.1 years) for cardiovascular death and heart failure admission. The extent and severity of angiographic disease were estimated with the use of the CAD prognostic index, and CFR was measured noninvasively by positron emission tomography. A modest inverse correlation was seen between CFR and CAD prognostic index (r=-0.26; P<0.0001). After adjustment for clinical risk score, ejection fraction, global ischemia, and early revascularization, CFR and CAD prognostic index were independently associated with events (hazard ratio for unit decrease in CFR, 2.02; 95% confidence interval, 1.20-3.40; P=0.008; hazard ratio for 10-U increase in CAD prognostic index, 1.17; 95% confidence interval, 1.01-1.34; P=0.032). Subjects with low CFR experienced rates of events similar to those of subjects with high angiographic scores, and those with low CFR or high CAD prognostic index showed the highest risk of events (P=0.001). There was a significant interaction (P=0.039) between CFR and early revascularization by coronary artery bypass grafting, such that patients with low CFR who underwent coronary artery bypass grafting, but not percutaneous coronary intervention, experienced event rates comparable to those with preserved CFR, independently of revascularization.
CFR was associated with outcomes independently of angiographic CAD and modified the effect of early revascularization. Diffuse atherosclerosis and associated microvascular dysfunction may contribute to the pathophysiology of cardiovascular death and heart failure, and impact the outcomes of revascularization.</abstract><cop>United States</cop><pmid>25400060</pmid><doi>10.1161/CIRCULATIONAHA.114.011939</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2015-01, Vol.131 (1), p.19-27 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Aged Cardiovascular Diseases - epidemiology Coronary Angiography Coronary Artery Bypass Coronary Artery Disease - physiopathology Coronary Artery Disease - therapy Coronary Vessels - diagnostic imaging Coronary Vessels - physiopathology Death, Sudden, Cardiac - epidemiology Female Follow-Up Studies Fractional Flow Reserve, Myocardial - physiology Heart Failure - epidemiology Humans Male Middle Aged Myocardial Infarction - epidemiology Percutaneous Coronary Intervention Positron-Emission Tomography Prognosis Regional Blood Flow - physiology Retrospective Studies Risk Factors Severity of Illness Index Treatment Outcome |
| title | Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization |
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