Feasibility, symptoms, adverse effects, and complications associated with noninvasive assessment of coronary flow velocity reserve in women with suspected or known coronary artery disease

Montisci, Roberta; Ruscazio, Massimo; Marchetti, Maria Francesca; Tuveri, Francesca; Cacace, Cristina; Congia, Michela; Zedda, N; Meloni, Luigi

doi:10.1111/echo.13630

Cited by 6 publications

(8 citation statements)

References 43 publications

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“…Our results are consistent with extensive data present in the literature since 20 years showing that CFVR is feasible (>80%) in combination with RWMA for all stresses, including semisupine exercise 15 and dobutamine, 16 but success rate is clearly higher with vasodilators 6 . The success rate is good (>50%) in all three coronary arteries, 17 but much easier, faster, and less technically demanding in LAD, 18 where the success rate has been invariably reported consistently above 90% in several studies, even without any contrast use and in morbidly obese patients 19‐21 . The data of our study corroborate previous evidences and add some new information, highlighting that a single multifrequency transducer approach is sufficient to obtain excellent feasibility results without compromising on RWMA.…”

Section: Discussionsupporting

confidence: 91%

“…The lack of contrast availability for reimbursement issues or safety concerns should not avoid the implementation of CFVR assessment. Second, its use is only recommended in patients with uninterpretable coronary flow tracings, usually <5% of consecutive populations as also shown in previous studies 20,23,24 . Therefore, a selective use of contrast (in <5% of patients) to enhance an otherwise undetectable color or pulsed‐Doppler signal in challenging patients (more frequently obese women) will further increase the already excellent feasibility of the method.…”

Section: Discussionmentioning

confidence: 89%

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Clinical, hemodynamic, and functional variables affecting success rate of coronary flow velocity reserve detection during vasodilator stress echocardiography

Cortigiani¹,

Bovenzi²

2020

Echocardiography

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Aim Stress echocardiography (SE) with state‐of‐the‐art imaging protocol allows a comprehensive assessment of regional wall‐motion abnormalities and Doppler‐based coronary flow velocity reserve (CFVR) in left anterior descending artery (LAD). We sought to assess the variables potentially impacting on success rate of SE with CFVR. Methods and results In a single‐center, prospective, observational study design, from 2007 to 2019, we enrolled 2989 consecutive patients (age 67 ± 12 years; 1723 men) referred for SE, without contrast, for chronic known (n = 1130) or suspected (n = 1859) coronary syndromes. Coronary flow velocity reserve was measured as stress/rest peak diastolic flow velocity. The same operator (LC) performed all examinations with the same machine (GE Vivid 7). Interpretable CFVR was obtained in 2808 patients (feasibility = 93.9%). Overall success rate was lowest (91.4%) in 2007–2008 and steadily rose to 97.8% in 2017–2019 (P for trend <.0001). Feasibility was excellent for men (93.7%) and women (94.3%) (P = .47) across all values of body mass index (BMI): <25 (P = .09), 25–29 (P = .84), and ≥30 (P = .23). At multivariable logistic regression analysis, women with BMI ≥ 30 (OR 1.94, 95% CI 1.14–3.29, P = .02), resting heart rate ≥77 beats/min (OR 2.25, 95% CI 1.64–3.11; P < .0001), and stress‐induced ischemia in the LAD territory (OR 3.14, 95% CI 1.67–5.90; P < .0001) predicted unfeasible CFVR. Conclusion Vasodilator SE with CFVR combined with wall‐motion analysis is highly feasible also without contrast although with a slight decline in presence of high resting heart rate (reducing diastolic time essential for flow imaging), women with BMI ≥ 30 (increasing tissue thickness interposed between transducer and artery), and anterior ischemia (for underlying low‐absent anterograde flow for severely stenotic or occluded LAD).

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 89%

Clinical, hemodynamic, and functional variables affecting success rate of coronary flow velocity reserve detection during vasodilator stress echocardiography

Cortigiani¹,

Bovenzi²

2020

Echocardiography

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“…Noninvasive CFR is a highly feasible, 48 AMI. CFR identifies microvascular integrity and viability indirectly, while MRI is a more accurate technique that allows a direct evaluation of the site and the extension of the myocardial necrosis 16,18 and of the microvascular obstruction.…”

Section: Discussionmentioning

confidence: 99%

Coronary flow reserve is related to the extension and transmurality of myocardial necrosis and predicts functional recovery after acute myocardial infarction

et al. 2019

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Background: Few studies have examined the effect of transmurality of myocardial necrosis on coronary microcirculation. The aim of this study was to examine the influence of cardiac magnetic resonance-derived (GE-MRI) structural determinants of coronary flow reserve (CFR) after anterior myocardial infarction (STEMI), and their predictive value on regional functional recovery. Methods:Noninvasive CFR and GE-MRI were studied in 37 anterior STEMI patients after primary coronary angioplasty. The wall motion score index in the left descending anterior coronary artery territory (A-WMSI) was calculated at admission and follow-up (FU). Recovery of regional left ventricular (LV) function was defined as the difference in A-WMSI at admission and FU. The necrosis score index (NSI) and transmurality score index (TSI) by GE-MRI were calculated in the risk area.Baseline (BMR) and hyperemic (HMR) microvascular resistance, arteriolar resistance index (ARI), and coronary resistance reserve (CRR) were calculated at the Doppler echocardiography.Results: Bivariate analysis indicated that the CPK and troponin I peak, heart rate, NSI, TSI, BMR, the ARI, and CRR were related to CFR. Multivariable analysis revealed that TSI was the only independent determinant of CFR. The CFR value of >2.27, identified as optimal by ROC analysis, was 77% specific and 73% sensitive with accuracy of 76% in identifying patients with functional recovery.Conclusions: Preservation of microvascular function after AMI is related to the extent of transmurality of myocardial necrosis, is an important factor influencing regional LV recovery, and can be monitored by noninvasive CFR. K E Y W O R D Sacute myocardial infarction, cardiac magnetic resonance imaging, coronary flow reserve, transthoracic echocardiography | 845 MONTISCI eT al.

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“…9,10 The coronary flow velocity reserve evaluated by transthoracic Doppler echocardiography is noninvasive, convenient and useful. 11 The coronary flow velocity reserve is also useful for evaluation after coronary artery bypass grafting. 12 In this study, it significantly decreased compared with that in the other groups without any significant stenotic lesions.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of coronary flow velocity reserve on transthoracic Doppler echocardiography in patients with a history of Kawasaki disease

Tsuda

Hashimoto

2021

Cardiol Young

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Whether the acute inflammation caused by Kawasaki disease will have an effect on the endothelial function of coronary arteries in the future is unknown. Methods: The coronary flow velocity reserve of the left anterior descending artery was examined by transthoracic Doppler echocardiography in 189 patients (male 125, female 64) with a history of Kawasaki disease and 10 volunteers (control). Their ages ranged from 6 to 40 years (median 22 years). The patients were divided into nine groups based on the left anterior descending artery lesions. The coronary flow velocity reserve was measured by intravenous administration of adenosine triphosphate (0.15 mg/kg/minute) while fasting. The coronary flow velocity reserve was calculated as the ratio of hyperaemic to basal mean diastolic flow velocities. The respective groups were as follows: control, no coronary artery lesions (n = 39), no coronary artery lesions in the right coronary artery (n = 29), regression (n = 11), aneurysm at the bifurcation of the left coronary artery (n = 26), aneurysm of the left anterior descending artery (n = 15), localised stenosis <75% (n = 12), localised stenosis ≥75% (n = 17), segmental stenosis (n = 5) and coronary artery bypass grafting (n = 36). One-factor ANOVA followed by Tukey’s test was used to compare the coronary flow velocity reserve among the groups. Results: The coronary flow velocity reserve was significantly lower in the localised stenosis ≥75%, segmental stenosis and coronary artery grafting groups than in the other groups (p < 0.05). Conclusions: The endothelial function in the epicoronary artery was preserved in patients with a history of Kawasaki disease and dilated coronary artery lesions.

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Feasibility, symptoms, adverse effects, and complications associated with noninvasive assessment of coronary flow velocity reserve in women with suspected or known coronary artery disease

Cited by 6 publications

References 43 publications

Clinical, hemodynamic, and functional variables affecting success rate of coronary flow velocity reserve detection during vasodilator stress echocardiography

Clinical, hemodynamic, and functional variables affecting success rate of coronary flow velocity reserve detection during vasodilator stress echocardiography

Coronary flow reserve is related to the extension and transmurality of myocardial necrosis and predicts functional recovery after acute myocardial infarction

Characteristics of coronary flow velocity reserve on transthoracic Doppler echocardiography in patients with a history of Kawasaki disease

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