Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Aug 2022)

Prognostic Impact of Coronary Flow Reserve in Patients With Reduced Left Ventricular Ejection Fraction

  • Hyun Sung Joh,
  • Doosup Shin,
  • Joo Myung Lee,
  • Seung Hun Lee,
  • David Hong,
  • Ki Hong Choi,
  • Doyeon Hwang,
  • Coen K. M. Boerhout,
  • Guus A. de Waard,
  • Ji‐Hyun Jung,
  • Hernan Mejia‐Renteria,
  • Masahiro Hoshino,
  • Mauro Echavarria‐Pinto,
  • Martijn Meuwissen,
  • Hitoshi Matsuo,
  • Maribel Madera‐Cambero,
  • Ashkan Eftekhari,
  • Mohamed A. Effat,
  • Tadashi Murai,
  • Koen Marques,
  • Joon‐Hyung Doh,
  • Evald H. Christiansen,
  • Rupak Banerjee,
  • Hyun Kuk Kim,
  • Chang‐Wook Nam,
  • Giampaolo Niccoli,
  • Masafumi Nakayama,
  • Nobuhiro Tanaka,
  • Eun‐Seok Shin,
  • Steven A. J. Chamuleau,
  • Niels van Royen,
  • Paul Knaapen,
  • Bon Kwon Koo,
  • Tsunekazu Kakuta,
  • Javier Escaned,
  • Jan J. Piek,
  • Tim P. van de Hoef

DOI
https://doi.org/10.1161/JAHA.122.025841
Journal volume & issue
Vol. 11, no. 15

Abstract

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Background Intracoronary physiologic indexes such as coronary flow reserve (CFR) and left ventricular ejection fraction (LVEF) have been regarded as prognostic indicators in patients with coronary artery disease. The current study evaluated the association between intracoronary physiologic indexes and LVEF and their differential prognostic implications in patients with coronary artery disease. Methods and Results A total of 1889 patients with 2492 vessels with available CFR and LVEF were selected from an international multicenter prospective registry. Baseline physiologic indexes were measured by thermodilution or Doppler methods and LVEF was recorded at the index procedure. The primary outcome was target vessel failure, which was a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization over 5 years of follow‐up. Patients with reduced LVEF <50% (162 patients [8.6%], 202 vessels [8.1%]) showed a similar degree of epicardial coronary artery disease but lower CFR values than those with preserved LVEF (2.4±1.2 versus 2.7±1.2, P<0.001), mainly driven by the increased resting coronary flow. Conversely, hyperemic coronary flow, fractional flow reserve, and the degree of microvascular dysfunction were similar between the 2 groups. Reduced CFR (≤2.0) was seen in 613 patients (32.5%) with 771 vessels (30.9%). Reduced CFR was an independent predictor for target vessel failure (hazard ratio, 2.081 [95% CI, 1.385–3.126], P<0.001), regardless of LVEF. Conclusions CFR was lower in patients with reduced LVEF because of increased resting coronary flow. Patients with reduced CFR showed a significantly higher risk of target vessel failure than did those with preserved CFR, regardless of LVEF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04485234.

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