Parma University Hospital, Parma.
IFC Istituto di Fisiologia Clinica, CNR, Pisa, Italy.
J Am Soc Echocardiogr. 2020 May;33(5):594-603. doi: 10.1016/j.echo.2020.01.007. Epub 2020 Mar 12.
Coronary flow velocity reserve (CFVR) measured in the left anterior descending artery during high-dose vasodilator stress echocardiography interrogates both epicardial and microcirculatory coronary function and has been inversely associated with chronic inflammation and microvascular dysfunction, as well as with the presence of obstructive coronary artery disease. Microvascular dysfunction and chronic inflammation are common mechanisms of disease in cardiovascular (CV) and non-CV conditions. We aimed to assess whether CFVR is associated with all-cause death, but more specifically with CV, cancer, and non-CV and noncancer (NCVNC) mortality, independently and increasingly over other demographic, clinical, and echocardiography variables.
One thousand two patients who underwent stress echocardiography were followed for a median of 8.2 years, with clinical, regional wall motion abnormalities (RWMAs), and CFVR data. The independent prognostic value of RWMA and CFVR regarding CV, cancer, or NCVNC mortality was evaluated adjusting for clinical variables. A prespecified subgroup of subjects with no RWMA or revascularization procedures during follow-up was also analyzed (n = 752), to exclude most participants with possible coronary artery disease and remove such confounding from the assessment of the potential association of CFVR and mortality.
A total of 161 patients (16%) died, 63 deaths being CV (39%), 52 from cancer (32%), and 46 (29%) from NCVNC causes. In comparison to CV mortality, cancer and NCVNC mortality were not associated with an ischemic RWMA at univariable analysis, while a CFVR < 2 was significantly associated with each category of cause-specific mortality. A CFVR < 2 or ≥2 separated a group of patients with 8-year 14.6% versus 1.2% CV mortality, 10.3% versus 0.4% cancer mortality, and 9.5% versus 1.5% NCVNC mortality.
The reduction of CFVR is independently associated with CV, cancer, and NCVNC death in a population clinically referred for suspected/known coronary artery disease. CFVR can act as a marker or a mechanism preceding and predicting mortality from a wide variety of diseases.
在高剂量血管扩张剂负荷超声心动图检查中测量的左前降支冠状动脉血流储备（CFVR）可同时评估心外膜和微血管的冠状动脉功能，并且与慢性炎症和微血管功能障碍以及存在阻塞性冠状动脉疾病呈负相关。微血管功能障碍和慢性炎症是心血管（CV）和非 CV 疾病的常见发病机制。我们旨在评估 CFVR 是否与全因死亡相关，特别是与 CV、癌症和非 CV 非癌症（NCVNC）死亡率相关，并且独立于其他人口统计学、临床和超声心动图变量的相关性逐渐增强。
1200 例接受负荷超声心动图检查的患者接受了中位数为 8.2 年的随访，随访期间记录了临床资料、区域性壁运动异常（RWMA）和 CFVR 数据。通过调整临床变量，评估 RWMA 和 CFVR 对 CV、癌症或 NCVNC 死亡率的独立预后价值。还分析了一组无 RWMA 或随访期间无血管重建手术的患者（n=752）的亚组，以排除可能患有冠状动脉疾病的大多数患者，并消除评估 CFVR 和死亡率之间潜在关联时的此类混杂因素。
共有 161 例患者（16%）死亡，63 例死亡为 CV（39%），52 例为癌症（32%），46 例为 NCVNC（29%）。与 CV 死亡率相比，癌症和 NCVNC 死亡率在单变量分析中与缺血性 RWMA 无关，而 CFVR<2 与每种特定原因的死亡率均显著相关。CFVR<2 或≥2 可将一组患者的 8 年 CV 死亡率区分开来，为 14.6%和 1.2%，癌症死亡率为 10.3%和 0.4%，NCVNC 死亡率为 9.5%和 1.5%。
在临床上怀疑/已知患有冠状动脉疾病的人群中，CFVR 的降低与 CV、癌症和 NCVNC 死亡独立相关。CFVR 可以作为一种标志物或机制，在各种疾病发生和发展之前发挥作用，并预测死亡率。
