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
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Figure 1 Protocol of Dipyridamole Stress Echocardiography
The stress protocol was based on the intermittent evaluation of wall motion and coronary flow reserve (CFR) in the left anterior descending artery during dipyridamole (DIP) infusion. BP = blood pressure; PW = pulsed wave; 2D echo = 2-dimensional echocardiography.
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Figure 3 Synthetic View of Different Coronary Anatomic and Prognostic CFR Conditions
A synthetic view of the different coronary anatomic (first row) and prognostic coronary flow reserve (CFR) conditions (last row) underlying wall motion and CFR response during stress (framed). In normal conditions (left), there is normal coronary anatomy (upper row), normal wall motion response (second row), and normal CFR response (third row), with 3-fold increase in peak diastolic flow velocity during stress (dotted) versus baseline (full profile). An abnormal CFR with normal wall motion response can be found in presence of prognostically meaningful microvascular disease (second column from left) or mild-to-moderate epicardial stenosis (third column from left). With more advanced epicardial coronary artery stenosis (far right column), the reduction of CFR is consistently associated with wall motion abnormalities of obvious unfavorable prognostic impact ( – = good prognosis; ± = possibly unfavorable prognosis; + = unfavorable prognosis; ++ = very unfavorable prognosis). CAD = coronary artery disease. Redrawn and modified from Picano et al. (32).
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