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The association between heart rate reserve and impaired coronary flow velocity reserve: a study based on adenosine stress echocardiography

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Abstract

This study was to explore the correlation between heart rate reserve (HRR) to coronary flow velocity reserve (CFVR), using adenosine stress echocardiography (SE), in patients with angina and no obstructive coronary artery disease (ANOCA). 111 ANOCA patients underwent adenosine SE were enrolled, which were divided into two groups, impaired CFVR group (CFVR < 2) and control groups (CFVR ≥ 2). The relationships between HRR and impaired CFVR were explored in total and subgroup to sex. A reduced HRR during adenosine infusion was seen in ANOCA patients with impaired CFVR (25.73 ± 8.39 vs. 34.30 ± 19.93, P < 0.001). Compared to respective controls, the blunted HRR to adenosine was more pronounced in female patients (women: 27.21 ± 8.01 vs. 39.48 ± 10.57, P < 0.001; men: 24.05 ± 8.70 vs. 29.12 ± 8.69, P = 0.041). A strong association between CFVR and a blunted HRR was observed in women (r = 0.46, P < 0.001), while no association in men (r = 0.18, P = 0.199). In female, a multivariate logistic regression identified HRR as the strongest negative predictor of impaired CFVR [HR (95% CI) = 0.854 (0.764–0.956), P = 0.006]. Based on the ROC curve, HRR < 35% was a strong indicator of impaired CFVR, with AUC of 0.838, sensitivity of 70%, and specificity of 87% in females. A blunted HRR was seen in patients with impaired CFVR, with a most pronounced effect being seen in female patients. The blunted HRR < 35% is intricately linked to impaired CFVR in women with ANOCA beyond the value of traditional risk factors, which could ultimately contribute to risk stratification of impaired CFVR in such patients.

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Acknowledgements

The authors thank all the participants for their cooperation and are grateful for the support of Department of Cardiac Function, People’s Hospital of Liaoning Province.

Funding

This work was supported by: the Science and Technology Fund of Liaoning Province (20180530109) and the Liaoning Province Xingliao Talents Plan Project (XLYC2005007).

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Authors and Affiliations

  1. Faculty of Medical Imaging and Nuclear Medicine, Graduate School of Dalian Medical University, Dalian, 116044, China

    Tingting Liu

  2. Department of Cardiac Function, People’s Hospital of Liaoning Province, Building 1, No.33, Wenyi Road, Shenhe District, Shenyang, 110000, China

    Tingting Liu, Mingyan Ding, Dandan Sun, Huihui Zhang, Lijuan Guo, Ying Li, Hanzhang Zhao & Fang Zhu

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Contributions

FZ proposed the conceptual design of the article, TL was responsible for data analysis and article drafting, DS and MD were responsible for data collection and gathering, and HZ, LG, YL and HZ were responsible for key revisions of the article.

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Correspondence to Fang Zhu.

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Ethics approval was obtained from the People’s Hospital of Liaoning Province. Each participant provided written informed consent after receiving a detailed description of the study.

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Liu, T., Ding, M., Sun, D. et al. The association between heart rate reserve and impaired coronary flow velocity reserve: a study based on adenosine stress echocardiography. Int J Cardiovasc Imaging 38, 1037–1046 (2022). https://doi.org/10.1007/s10554-021-02480-0

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