Arquivos Brasileiros de Cardiologia ()

Prognostic Value of Coronary Flow Reserve Obtained on Dobutamine Stress Echocardiography and its Correlation with Target Heart Rate

  • José Sebastião de Abreu,
  • Eduardo Arrais Rocha,
  • Isadora Sucupira Machado,
  • Isabelle Oliveira Parahyba,
  • Thaís de Brito Rocha,
  • Fernando José Villar Nogueira Paes,
  • Tereza Cristina Pinheiro Diogenes,
  • Marília Esther Benevides de Abreu,
  • Ana Gardenia Liberato Ponte Farias,
  • Marcia Maria Carneiro,
  • José Nogueira Paes Junior

DOI
https://doi.org/10.5935/abc.20170041
Journal volume & issue
Vol. 108, no. 5
pp. 417 – 426

Abstract

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Abstract Background: Normal coronary flow velocity reserve (CFVR) (≥ 2) obtained in the left anterior descending coronary artery (LAD) from transthoracic echocardiography is associated with a good prognosis, but there is no study correlating CFVR with submaximal target heart rate (HR). Objective: To evaluate the prognostic value of CFVR obtained in the LAD of patients with preserved (>50%) left ventricular ejection fraction (LVEF) who completed a dobutamine stress echocardiography (DSE), considering target HR. Methods: Prospective study of patients with preserved LVEF and CFVR obtained in the LAD who completed DSE. In Group I (GI = 31), normal CFVR was obtained before achieving target HR, and, in Group II (GII = 28), after that. Group III (G III=24) reached target HR, but CFVR was abnormal. Death, acute coronary insufficiency, coronary intervention, coronary angiography without further intervention, and hospitalization were considered events. Results: In 28 ± 4 months, there were 18 (21.6%) events: 6% (2/31) in GI, 18% (5/28) in GII, and 46% (11/24) in GIII. There were 4 (4.8%) deaths, 6 (7.2%) coronary interventions and 8 (9.6%) coronary angiographies without further intervention. In event-free survival by regression analysis, GIII had more events than GI (p < 0.001) and GII (p < 0.045), with no difference between GI and GII (p = 0.160). After adjustment, the only difference was between GIII and GI (p = 0.012). Conclusion: In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis.

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