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J Am Coll Cardiol, 2007; 50:1354-1361, doi:10.1016/j.jacc.2007.06.027
(Published online 14 September 2007). © 2007 by the American College of Cardiology Foundation |
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* Cardiology Division, Campo di Marte Hospital, Lucca, Italy
Cardiology Division, Umberto I° Hospital, Mestre, Italy
Cardiology Division, Cesena Hospital, Cesena, Italy
CNR, Institute of Clinical Physiology, Pisa, Italy
|| Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy.
Manuscript received April 26, 2007; revised manuscript received June 6, 2007, accepted June 20, 2007.
* Reprint requests and correspondence: Dr. Lauro Cortigiani, Divisione di Cardiologia Ospedale "Campo di Marte," 55032 Lucca, Italy. (Email: lacortig{at}tin.it).
Objectives: The aim of this prospective, multicenter, observational study was to compare the prognostic value of Doppler echocardiographic-derived coronary flow reserve (CFR) in diabetic and nondiabetic patients with known or suspected coronary artery disease and negative dipyridamole stress echocardiography.
Background: The prognostic value of CFR in diabetic patients with negative stress echocardiography remains unknown.
Methods: The study group consisted of 1,130 patients (207 diabetics) with known (n = 418) or suspected (n = 712) coronary artery disease and negative stress echocardiography by wall motion criteria. All underwent dipyridamole (up to 0.84 mg/kg over 6 min) echocardiography with CFR evaluation of left anterior descending artery by Doppler. A value of CFR
2.0 was considered abnormal.
Results: Coronary flow reserve was abnormal in 309 (27%) patients. During a median follow-up of 16 months, 98 events (8 deaths, 24 ST-segment elevation myocardial infarctions, and 66 non–ST-segment elevation myocardial infarctions) occurred. In addition, 101 patients underwent revascularization and were censored. Multivariable prognostic indicators were abnormal CFR (p < 0.0001), anti-ischemic therapy at the time of testing (p = 0.002), age (p = 0.02), and resting wall motion abnormality (p = 0.05). The event rate was markedly higher (p < 0.0001) for both diabetic and nondiabetic patients with abnormal CFR as compared with diabetic and nondiabetic patients with normal CFR. Of note, a preserved CFR off therapy identified diabetic and nondiabetic patients with better survival and comparable yearly event rates (2.2% vs. 2.0%, p = 0.80).
Conclusions: Coronary flow reserve provides independent prognostic information in diabetic and nondiabetic patients with known or suspected coronary artery disease and negative dipyridamole stress echocardiography. In particular, a normal CFR off therapy is associated with better and similar survival in the 2 populations.
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