Cortigiani Lauro, Gaibazzi Nicola, Ciampi Quirino, Tuttolomondo Domenico, Navacchi Rebecca, Bovenzi Francesco, Carerj Scipione, Pepi Mauro, Pellikka Patricia A, Picano Eugenio
Cardiology Division, San Luca Hospital, Lucca, Italy.
Ospedale San Luca, Via Guglielmo Lippi Francesconi, Lucca, 55100, Italy.
Int J Cardiovasc Imaging. 2025 May 16. doi: 10.1007/s10554-025-03411-z.
Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery.
To assess the value of SE with RWMA and CFVR to predict survival in PAD.
In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69 ± 8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value ≤ 2.0). All patients were followed up for a median of 4.7 (interquartile range: 2.0 to 8.2 years). All-cause death was the outcome end-point.
The positivity rate was 37/359 (10%) for RWMA and 159/359 (44%) for CFVR. During follow-up, 97 (27%) deaths were registered. At multivariable analysis, inducible RWMA and/or CFVR ≤ 2.0 (HR 2.58, 95% CI 1.65-4.04; p < 0.0001), age ≥ 70 years, diabetes, dialysis treatment, and ejection fraction ≤ 50% were associated with decreased survival. The annual mortality was 7.4% in patients with RWMA and/or CFVR ≤ 2.0 and 2.7% in those with no RWMA and CFVR > 2.0 (p < 0.0001).
In patients with PAD, SE shows more than 4-fold higher prevalence of abnormal CFVR compared to RWMA. The prognostic value of CFVR outperforms RWMA, showing the importance of coronary microvascular dysfunction and diffuse, subcritical coronary atherosclerosis in determining the outcome.
下肢外周动脉疾病（PAD）患者发生心血管事件的风险更高。基于节段性室壁运动异常（RWMA）的负荷超声心动图（SE）在PAD风险分层方面并不完善，但可通过评估左前降支冠状动脉中远段的冠状动脉血流储备（CFVR）来补充。
评估结合RWMA和CFVR的SE对预测PAD患者生存的价值。
在一项观察性多中心研究的前瞻性收集数据的回顾性分析中，我们招募了359例（年龄69±8岁，240例[67%]为男性）PAD患者，这些患者在3个认可的实验室接受双嘧达莫SE检查。我们评估了RWMA和CFVR（异常值≤2.0）。所有患者的中位随访时间为4.7年（四分位间距：2.0至8.2年）。全因死亡为结局终点。
RWMA的阳性率为37/359（10%），CFVR的阳性率为159/359（44%）。随访期间，登记了97例（27%）死亡病例。在多变量分析中，诱发性RWMA和/或CFVR≤2.0（HR 2.58，95%CI 1.65 - 4.04；p<0.0001）、年龄≥70岁、糖尿病、透析治疗以及射血分数≤50%与生存率降低相关。RWMA和/或CFVR≤2.0的患者年死亡率为7.4%，无RWMA且CFVR>2.0的患者年死亡率为2.7%（p<0.0001）。
在PAD患者中，与RWMA相比，SE显示CFVR异常的患病率高出4倍多。CFVR的预后价值优于RWMA，表明冠状动脉微血管功能障碍和弥漫性、亚临界冠状动脉粥样硬化在决定结局方面的重要性。
