Abreu José Sebastião de, Rocha Eduardo Arrais, Machado Isadora Sucupira, Parahyba Isabelle O, Rocha Thais Brito, Paes Fernando José Villar Nogueira, Diogenes Tereza Cristina Pinheiro, Abreu Marília Esther Benevides de, Farias Ana Gardenia Liberato Ponte, Carneiro Marcia Maria, Paes José Nogueira
Clínica Clinicárdio, de Fortaleza, CE - Brazil.
Hospital Prontocárdio, Fortaleza, CE - Brazil.
Arq Bras Cardiol. 2017 May;108(5):417-426. doi: 10.5935/abc.20170041. Epub 2017 Apr 20.
: 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).
: 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.
: 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.
: 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).
: In patients with preserved LVEF and who completed their DSE, normal CFVR obtained before achieving target HR was associated with better prognosis.
: A reserva de velocidade de fluxo coronariano (RVFC) adequada (≥ 2) obtida na artéria descendente anterior (ADA) através do ecocardiograma transtorácico associa-se a bom prognóstico, mas não há estudo correlacionando-a com a frequência cardíaca (FC) alvo (submáxima).
: Avaliar o valor prognóstico da RVFC obtida na ADA de pacientes com fração de ejeção do ventrículo esquerdo (FEVE) preservada (>50%) e ecocardiograma sob estresse com dobutamina (EED) concluído, considerando a FC alvo submáxima.
MÉTODOS:: studo prospectivo de pacientes com FEVE preservada e RVFC obtida na ADA durante EED concluído. No Grupo I (GI=31), a RVFC adequada foi obtida antes de se atingir a FC alvo, e no Grupo II (G II=28), após. O Grupo III (G III=24) atingiu a FC alvo, mas a RVFC foi inadequada. Foram considerados eventos: óbito, insuficiência coronariana aguda, intervenção coronariana, coronariografia sem intervenção subsequente e internamento hospitalar.
: Em 28 ± 4 meses, ocorreram 18 (21,6%) eventos, sendo 6% (2/31) no GI, 18% (5/28) no GII e 46% (11/24) no GIII. Foram 4 (4,8%) óbitos, 6 (7,2%) intervenções coronarianas e 8 (9,6%) coronariografias sem intervenção subsequente. Na sobrevida livre de eventos pela análise de regressão, GIII apresentou mais eventos do que GI (p < 0,001) ou GII (p < 0,045), não havendo diferença entre GI e GII (p = 0,160). Após o ajustamento, foi mantida a diferença apenas entre GIII e GI (p = 0,012).
CONCLUSÃO:: Em pacientes com FEVE preservada e EED concluído, a RVFC adequada obtida antes da FC alvo associou-se ao melhor prognóstico.
经胸超声心动图测得的左前降支冠状动脉（LAD）正常冠状动脉血流速度储备（CFVR）（≥2）与良好预后相关，但尚无研究将CFVR与次极量目标心率（HR）相关联。
评估在完成多巴酚丁胺负荷超声心动图（DSE）的左心室射血分数（LVEF）保留（>50%）患者的LAD中获得的CFVR的预后价值，同时考虑目标心率。
对完成DSE且LVEF保留并在LAD中获得CFVR的患者进行前瞻性研究。在第一组（GI = 31）中，在达到目标心率之前获得正常CFVR，在第二组（GII = 28）中，在达到目标心率之后获得正常CFVR。第三组（GIII = 24）达到目标心率，但CFVR异常。死亡、急性冠状动脉供血不足、冠状动脉介入、未进一步干预的冠状动脉造影以及住院被视为事件。
在28±4个月内，发生了18例（21.6%）事件：GI组为6%（2/31），GII组为18%（5/28），GIII组为46%（11/24）。有4例（4.8%）死亡，6例（7.2%）冠状动脉介入和8例（9.6%）未进一步干预的冠状动脉造影。通过回归分析的无事件生存率显示，GIII组的事件比GI组更多（p < 0.001），比GII组更多（p < 0.045），GI组和GII组之间无差异（p = 0.160）。调整后，唯一的差异存在于GIII组和GI组之间（p = 0.012）。
在LVEF保留且完成DSE的患者中，在达到目标心率之前获得的正常CFVR与更好的预后相关。
通过经胸超声心动图在左前降支动脉（LAD）获得的适当冠状动脉血流速度储备（RVFC）（≥2）与良好的预后相关，但没有研究将其与目标心率（次极量）相关联。
评估在完成多巴酚丁胺负荷超声心动图（EED）且左心室射血分数（FEVE）保留（>50%）的患者的LAD中获得的RVFC的预后价值，同时考虑次极量目标心率。
对完成EED且FEVE保留并在LAD中获得RVFC的患者进行前瞻性研究。在第一组（GI = 31）中，在达到目标心率之前获得适当的RVFC，在第二组（GII = 28）中，在达到目标心率之后获得。第三组（GIII = 24）达到目标心率，但RVFC不适当。被视为事件的有：死亡、急性冠状动脉功能不全、冠状动脉介入、无后续干预的冠状动脉造影以及住院治疗。
在28±4个月内，发生了18例（21.6%）事件，GI组为6%（2/31），GII组为18%（5/28），GIII组为46%（11/24）。有4例（4.8%）死亡，6例（7.2%）冠状动脉介入和8例（9.6%）无后续干预의冠状动脉造影。通过回归分析的无事件生存率显示，GIII组的事件比GI组更多（p < 0.001）或比GII组更多（p < 0.045），GI组和GII组之间无差异（p = 0.160）。调整后，仅在GIII组和GI组之间维持差异（p = 0.012）。
在FEVE保留且EED完成的患者中，在目标心率之前获得的适当RVFC与更好的预后相关。
