Abstract 2724: The Additive Prognostic Value of Wall Motion Abnormalities and Coronary Flow Reserve During Dipyridamole Stress Echo
Objectives: The aim of the study was to evaluate the prognostic value of Doppler echocardiographic derived coronary flow reserve (CFR) over regional wall motion in patients with known or suspected coronary artery disease undergoing Dipyridamole Echocardiography test (DET).
Methods: In a prospective, multicenter, observational study, we evaluated 1145 patients (702 males; 64±11 years) who underwent high dose dipyridamole (0.84 mg/Kg over 10’) stress echo with CFR evaluation of LAD by Doppler.
Results: DET was positive for regional wall motion abnormalities in 291 (25%) and negative in 854 (74%) patients. Mean CFR was 2.2±0.5. At individual patient analysis 702 patients had normal (CFR>2.0) and 443 had abnormal CFR on LAD. During a mean follow-up of 36 months 33 events occurred: 16 deaths and 17 nonfatal myocardial infarctions. The 30 months infarction-free survival showed a significant better outcome for those patients with negative DET by wall motion criteria and normal CFR (see figure⇓). At multivariable analysis, angina on effort (hazard ratio [HR] 7.3, 95% CI 3.4–16.1, p<0.001), medical therapy at time of testing (hazard ratio [HR] 3.6, 95% CI 1.6 – 8.3, P =0.002), DET positivity for regional wall motion abnormalities (hazard ratio [HR] 5.4, 95% CI 2.5–11.8, p<0.001), a CFR of LAD <2 (hazard ratio [HR] 2.5, 95% CI 1.2–5.21, P =0.013), were independent prognostic predictors of events.
Conclusions: In patients with known or suspected coronary artery disease DET result by wall motion criteria and CFR are additive and complementary for the identification of patients at higher risk of experiencing hard events.