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Long‐term prognostic role of coronary flow velocity reserve in patients with aortic valve stenosis – insights from the SZEGED Study
Author(s) -
Nemes Attila,
Balázs Erika,
Csanády Miklós,
Forster Tamás
Publication year - 2009
Publication title -
clinical physiology and functional imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.608
H-Index - 67
eISSN - 1475-097X
pISSN - 1475-0961
DOI - 10.1111/j.1475-097x.2009.00893.x
Subject(s) - medicine , cardiology , coronary flow reserve , dipyridamole , coronary artery disease , hazard ratio , stenosis , proportional hazards model , receiver operating characteristic , doppler echocardiography , aortic valve stenosis , blood pressure , confidence interval , diastole
Summary Introduction: Coronary flow velocity reserve (CFR) is markedly reduced in severe aortic valve stenosis (AS). Independent prognostic value of pulsed‐wave Doppler echocardiography‐derived CFR was seen in a variety of diseases. However, the prognostic significance of CFR by pulsed‐wave Doppler echocardiography has never been evaluated in patients with AS. Methods: A total of 49 AS patients (mean age: 63 ± 9 years, 26 men) were enrolled in this prospective follow‐up study; they all had undergone standard transthoracic Doppler‐echo study, coronary angiography and dipyridamole stress transoesophageal echocardiography as CFR measurement. Results: During a mean follow‐up of 82 ± 38 months, 18 patients suffered cardiovascular death and one patient had non‐fatal stroke. Other two patients underwent reoperation of dysfunctional prosthetic aortic valve. Using receiver operator curve (ROC) analysis, CFR <2·13 had the highest accuracy in predicting cardiovascular outcome (sensitivity 90%, specificity 46%, area under the curve 66%, P = 0·02). By univariable analysis, diabetes mellitus, hypertension, presence of coronary artery disease and lower CFR were significant predictors of cardiovascular morbidity and mortality. Multivariable regression analysis showed that only lower CFR [hazard ratio (HR) 1·67, 95% CI of HR: 1·05–4·29, P < 0·05] was independent predictor of cardiovascular outcome. Discussion: Long‐term prognostic significance of CFR for prediction of cardiovascular morbidity and mortality has been demonstrated during a 9‐year follow‐up in patients with AS. Despite a relatively small number of patients were followed, CFR was found to be an independent predictor for future cardiovascular events in AS patients.