Coronary Flow Reserve Is a Comprehensive Indicator of Cardiovascular Risk Factors in Subjects With Chest Pain and Normal Coronary Angiogram

Abstract

Background:The aim of the present study was to analyze the parameters related to baseline coronary flow velocity (CFV) and coronary flow reserve (CFR) using Doppler transthoracic echocardiography (TTE), and to assess their associations with components of the Framingham risk score (FRS), which estimates 10-year risk of coronary heart disease, in subjects with chest pain and a normal coronary angiogram. Methods and Results:A total of 354 individuals (mean age: 55±11 years, M:F ratio =186:168) with angina or angina-like chest pain and a normal coronary arteriogram were enrolled. CFR, using TTE and adenosine or dipyridamole, was measured within 2 weeks after coronary angiogram. The clinical, electrocardiographic, echocardiographic and laboratory parameters related to baseline CVF and CFR were analyzed, and CFR was compared with FRS. There was an inverse correlation between baseline CFV and CFR (r=-0.374, P<0.001). On multivariate analysis the fulfilling of left ventricular hypertrophy criteria on electrocardiography was an independent predictor of baseline CFV for the upper 75% quartile (23.2≥cm/s; odds ratio (OR) = 2.840, 95% confidence interval (CI) = 1.155-6.983, P=0.023). On multivariate analysis hemoglobin A1c level was independently related to a CFR <2.0 (OR = 2.195, 95%CI = 0.920-1.005, P=0.013). CFR had an inverse correlation with FRS (r=-0.222, P<0.001). On multiple regression analysis among the components of the FRS system (FRSS), independent factors related to a CFR <2.0 included age (OR =1.033, 95%CI =1.000-1.067, P=0.041), high-density lipoprotein-cholesterol level (OR = 0.961, 95%CI = 0.933-0.991, P=0.012) and smoking status (OR = 2.461, 95%CI =1.078-5.618, P=0.033), respectively.Conclusions: CFR can be a comprehensive indicator of cardiovascular risk factors, including parameters of the FRSS, in subjects with chest pain and a normal coronary angiogram. (Circ J 2010; 74: 1405 - 1414

Coronary Microvascular Dysfunction ― Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy ―

“…62 Another study demonstrated that smoking status is associated with CFR <2, with an odds ratio of 2.246 (95% confidence interval 1.078-5.618, P=0.033). 63 Diabetics have reduced CFR. 64, 65 It is not surprising that hyperglycemia adversely affects the coronary microvasculature given the effect of diabetes on other microcirculations (i.e., retina, kidney and neuron).…”

Coronary Slow Flow

“…Lee et al showed that coronary flow reserve is low in patients presenting with angina and with normal coronary arteries, and is an indicator of cardiovascular risk factors. 26 Future studies should explore the intracoronary indices and classify patients accordingly.…”

Impaired Coronary Flow Reserve as a Marker of Microvascular Dysfunction to Predict Long-Term Cardiovascular Outcomes, Acute Coronary Syndrome and the Development of Heart Failure

“…14, 15 Based on its non-invasive, relative inexpensive, and physiological nature, TTDE-derived CFR measurement opens intriguing applications not only to diagnose obstructive coronary artery narrowing, 2,3 but also to assess microvascular function after modification of various coronary risk factors. [16][17][18][19] Previous reports showed the prognostic value of reduced CFR in patients with non-obstructive CAD. 4-6 Cortigiani et al reported that impaired CFR, defined as a CFR less than 2.0, was associated with cardiac death and ACS events in 1,130 CAD patients with negative dipyridamole stress echocardiography during a 16 month follow up.…”