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

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Author(s)

    • NAKANISHI Koki
    • Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine
    • SHIMADA Kenei
    • Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine
    • MIYAZAKI Chinami
    • Department of Cardiovascular Medicine, Higashisumiyoshi Morimoto Hospital
    • OTSUKA Kenichiro
    • Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine
    • YOSHIYAMA Minoru
    • Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine

Abstract

<b><i>Background:</i></b> In the absence of obstructive coronary narrowing, impaired coronary flow reserve (CFR) represents coronary microvascular dysfunction. Transthoracic Doppler echocardiography (TTDE) allows non-invasive measurement of CFR in the left anterior descending (LAD) artery. This study aimed to assess the prognostic value of TTDE-derived CFR (as a marker of microvascular function) in predicting long-term cardiovascular events, acute coronary syndrome (ACS) events, and the development of heart failure (HF). <b><i>Methods and Results:</i></b> This study consisted of 272 patients with coronary artery disease not involving obstructive narrowing (≥50%) in the LAD. Patients underwent TTDE examination for CFR measurement in the LAD. During the follow-up period of 4.0±1.9 years, 32 patients (12%) had cardiovascular events. Cox proportional hazard analysis identified lower CFR as an independent risk factor of cardiovascular events (P<0.001), ACS events (P=0.008), and HF development (P=0.003). A CFR less than 2.4 was the best cut-off value for predicting all events (area under the curve=0.82). CFR excellently predicted the development of HF (area under the curve=0.95), but not ACS events (area under the curve=0.67). <b><i>Conclusions:</i></b> This TTDE study demonstrated that CFR was a significant and independent determinant of long-term cardiovascular events, ACS events and HF in patients with coronary artery disease. A CFR greater than 2.0 was not suitable to predict a favorable long-term outcome, even in the absence of obstructive coronary narrowing.  (<i>Circ J</i> 2012; <b>76:</b> 1958–1964)<br>

Journal

  • Circulation Journal

    Circulation Journal 76(8), 1958-1964, 2012-07-25

    The Japanese Circulation Society

References:  41

Cited by:  3

Codes

  • NII Article ID (NAID)
    10030504808
  • NII NACSIS-CAT ID (NCID)
    AA11591968
  • Text Lang
    ENG
  • Article Type
    Journal Article
  • ISSN
    13469843
  • Data Source
    CJP  CJPref  J-STAGE 
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