Abstract 14109: Incremental Prognostic Value of Adenosine-assisted Coronary Flow Reserve Measurement in Left Anterior Descending Artery in One-Year Follow-up of Patients with Suspected Coronary Artery Disease
Objectives: The additional value of coronary flow reserve (CFR) over standard dipyridamole stress echocardiography in predicting major adverse cardiovascular events (MACE) has been established. However, data about adenosine-assisted CFR is still lacking. We sought to determine optimal cut-off value for CFR in left anterior descending artery (LAD) during adenosine infusion in patients with suspected coronary artery disease (CAD), and hypothesized that CFR may have independent prognostic value over clinical risk factors.
Methods: Four hundred patients (age 62±9 years, 47% male) with suspected CAD were included. CFR in LAD was assessed by transthoracic Doppler echocardiography during adenosine infusion (140 μg/kg/min) and defined as ratio between mean hyperemic and baseline diastolic flow velocity. All patients were followed up one year later regarding MACE, including death, myocardial infarction, stroke, revascularization by percutaneous coronary intervention or coronary artery bypass grafting, angina requiring hospitalization and transient ischemic attack.
Results: Mean CFR (± SD) was 2.71 ± 0.94 in this patient group. During a median follow-up of 370 days 60 MACE occurred. CFR was reduced in patients with MACE compared to those without (2.23 ± 1.04 vs. 2.80 ± 0.90, P < 0.001). When dividing CFR into tertiles (<2.28, 2.29–2.97, >2.98), there is a significant positive relationship between CFR-magnitude and event-free survival time by Kaplan-Meier analysis (P < 0.001). ROC analysis regarding MACE identified optimal cut-off of CFR < 1.8 with sensitivity, specificity, positive predictive value and negative predictive value of 42%, 90%, 43%, 90%, respectively. In a logistic regression model, adjusting for age, gender, hypertension, diabetes mellitus, ejection fraction, apo-lipoprotein A and B, CFR < 1.8 remained the strongest independent predictor (P < 0.001, OR 4.3, CI 2.0–9.3) alongside age, male gender and diabetes mellitus.
Conclusions: Adenosine-assisted CFR in LAD is a strong independent predictor of MACE in one-year follow-up of patients with suspected CAD and conveys incremental prognostic value compared to traditional clinical risk factors in this patient population.
- © 2010 by American Heart Association, Inc.