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CLINICAL RESEARCH: CARDIAC IMAGING

Additional Prognostic Value of Coronary Flow Reserve in Diabetic and Nondiabetic Patients With Negative Dipyridamole Stress Echocardiography by Wall Motion Criteria

Lauro Cortigiani, MD^_*,_*, Fausto Rigo, MD, FESC, Sonia Gherardi, MD, Rosa Sicari, MD, PhD, FESC, Maurizio Galderisi, MD, FESC^||, Francesco Bovenzi, MD^_* and Eugenio Picano, MD, PhD, FESC

^_* 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.

Abbreviations and Acronyms   CAD = coronary artery disease   CFR = coronary flow reserve   LAD = left anterior descending coronary artery   NSTEMI = non–ST-segment elevation myocardial infarction   STEMI = ST-segment elevation myocardial infarction

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