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Tesi etd-09132019-180417


Thesis type
Tesi di specializzazione (4 anni)
Author
LOMBARDO, ALBERTO
URN
etd-09132019-180417
Title
Age- and Gender-specific Prognostic Cutoff Values of Coronary Flow Velocity Reserve in Vasodilator Stress Echocardiography
Struttura
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Corso di studi
MALATTIE DELL'APPARATO CARDIOVASCOLARE
Supervisors
relatore Prof. Pedrinelli, Roberto
relatore Dott. Bovenzi, Francesco Maria
Parole chiave
  • coronary flow velocity reserve
  • stress echocardiography
Data inizio appello
04/11/2019;
Consultabilità
Secretata d'ufficio
Data di rilascio
04/11/2089
Riassunto analitico
Background. Coronary flow velocity reserve (CFVR) of left anterior descending artery (LAD) is useful for risk stratification during stress echocardiography (SE) as an add-on to regional wall motion abnormalities (RWMA). The aim of this study was to provide sex and age-specific prognostic cut-off values which may be needed to account for the physiologic decline of CFVR with age and sex-related differences in resting flow.
Methods. A total of 5,577 patients (of them, 2,284 women and 110 aged ≥85 years) were enrolled in a multicenter prospective SE registry. All underwent dual imaging (RWMA and CFVR of LAD) dipyridamole SE (0.84 mg/kg over 6'). All-cause death and non-fatal myocardial infarction were the only considered end-points.
Results. During a median follow-up of 20 months (1st quartile 8, 3rd quartile 43 months), there were 649 hard events (236 deaths and 413 non-fatal myocardial infarctions), 288 of which occurred in women and 38 in patients ≥85 years. With a ROC analysis, the best prognostic cut-off value for CFVR was almost the same for men (2.03) and women (2.02) and consistent across all age strata (<45 years: 2.03; 45-54 years: 2.04; 45-64 years: 2.03; 65-74 and 75-84 years: 2.0) except for the very elderly (>85 years) who showed an optimal value of 1.90. Independent prognostic indicators were RWMA (HR=5.42), reduced CFVR (HR=3.26), resting ejection fraction (HR=0.98), smoking habit (HR=1.41), age (HR=1.02), and prior PCI (HR=1.20) in patients aged <85 years, and RWMA (HR=5.42), smoking habit (HR=3.24), and resting ejection fraction (HR=0.97) in those aged >85 years. At interactive clinically realistic multivariable analysis, SE with CFVR demonstrated additional prognostic contribution over clinical parameters, resting ejection fraction and stress-induced RWMA in all age and sex groups except men older than 85 years.
Conclusion. A sex-independent cut-off value of CFVR ≤2.0 provides the optimal risk stratification across all age groups, except those >85 years in whom a lower cut-off <1.90 is needed. Risk stratification is more effective for all age groups when CFVR is combined with RWMA.
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