• Quirino Ciampi, Angela Zagatina, Lauro Cortigiani, Nicola Gaibazzi, Clarissa Borguezan Daros, Nadezhda Zhuravskaya, Karina Wierzbowska-Drabik, Jaroslaw D Kasprzak, José Luis de Castro E Silva Pretto, Antonello D'Andrea, Ana Djordjevic-Dikic, Ines Monte, Iana Simova, Alla Boshchenko, Rodolfo Citro, Miguel Amor, Pablo Martin Merlo, Claudio Dodi, Fausto Rigo, Suzana Gligorova, Milica Dekleva, Sergio Severino, Fabio Lattanzi, Maria Chiara Scali, Alexander Vrublevsky, Marco A R Torres, Alessandro Salustri, Hugo Rodrìguez-Zanella, Fabio Marco Costantino, Albert Varga, Eduardo Bossone, Paolo Colonna, Michele De Nes, Marco Paterni, Clara Carpeggiani, Jorge Lowenstein, Dario Gregori, Eugenio Picano, and Stress Echo 2020 Study Group of the Italian Society of Echocardiography and Cardiovascular Imaging.
• Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy.
• J. Am. Coll. Cardiol. 2019 Nov 5; 74 (18): 2278-2291.

BackgroundThe assessment of coronary flow velocity reserve (CFVR) in left anterior descending coronary artery (LAD) expands the risk stratification potential of stress echocardiography (SE) based on stress-induced regional wall motion abnormalities (RWMA).ObjectivesThe purpose of this study was to assess the feasibility and functional correlates of CFVR.MethodsThis prospective, observational, multicenter study initially screened 3,410 patients (2,061 [60%] male; age 63 ± 11 years; ejection fraction 61 ± 9%) with known or suspected coronary artery disease and/or heart failure. All patients underwent SE (exercise, n = 1,288; vasodilator, n = 1,860; dobutamine, n = 262) based on new or worsening RWMA in 20 accredited laboratories of 8 countries. CFVR was calculated as the stress/rest ratio of diastolic peak flow velocity pulsed-Doppler assessment of LAD flow. A subset of 1,867 patients was followed up.ResultsThe success rate for CFVR on LAD was 3,002 of 3,410 (feasibility = 88%). Reduced (≤2.0) CFVR was found in 896 of 3,002 (30%) patients. At multivariable logistic regression analysis, inducible RWMA (odds ratio [OR]: 6.5; 95% confidence interval [CI]: 4.9 to 8.5; p < 0.01), abnormal left ventricular contractile reserve (OR: 3.4; 95% CI: 2.7 to 4.2; p < 0.01), and B-lines (OR: 1.5; 95% CI: 1.1 to 1.9; p = 0.01) were associated with reduced CFVR. During a median follow-up time of 16 months, 218 events occurred. RWMA (hazard ratio: 3.8; 95% CI: 2.3 to 6.3; p < 0.001) and reduced CFVR (hazard ratio: 1.5; 95% CI: 1.1 to 2.2; p = 0.009) were independently associated with adverse outcome.ConclusionsCFVR is feasible with all SE protocols. Reduced CFVR is often accompanied by RWMA, abnormal LVCR, and pulmonary congestion during stress, and shows independent value over RWMA in predicting an adverse outcome.Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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