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Prognostic value of coronary flow reserve and aortic distensibility indices in patients with suspected coronary artery disease

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Abstract

In recent studies it has been demonstrated that a reduced coronary flow reserve (CFR) is independently associated with a less benign long-term outcome. Aortic stiffness is one of the most important cardiovascular risk factors predicting cardiovascular morbidity and mortality. Vasodilator stress transesophageal echocardiography (TEE) is a suitable method to evaluate simultaneously CFR and elastic properties of the descending thoracic aorta. The aim of the present study was to assess the relative prognostic value of simultaneously measured CFR and aortic elastic properties by pulsed-wave Doppler TEE in patients with suspected or known coronary artery disease (CAD). The study comprised 157 in-hospital patients with chest pain. In all patients, stress TEE was used for the simultaneous evaluation of CFR and aortic distensibility indices [elastic modulus E(p) and Young’s circumferential static elastic modulus E(s)]. During a mean follow-up of 48 ± 8 months, 13 patients suffered cardiovascular death. By univariate analysis older age, diabetes mellitus, increased left ventricular (LV) end-diastolic diameter, increased LV mass index, lower LV ejection fraction, and lower CFR were significant predictors of cardiovascular survival. Multivariate regression analysis showed that only CFR (hazard ratio [HR] 10.31, P = 0.04), age (HR 1.20, P = 0.001), and increased left ventricular (LV) end-diastolic diameter (HR 1.14, P = 0.02) were independent predictors of cardiovascular survival. Only in the small number of patients without CAD and abnormal CFR aortic distensibility seemed to provide complementary prognostic information over CFR. In the majority of patients aortic distensibility did not offer complementary prognostic information to CFR during vasodilator stress TEE testing.

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Authors and Affiliations

  1. 2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Centre, University of Szeged, Korányi fasor 6, P.O. Box 427, H-6720, Szeged, Hungary

    Attila Nemes, Tamás Forster & Miklós Csanády

  2. Department of Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, the Netherlands

    Attila Nemes, Marcel L. Geleijnse, Osama I. I. Soliman & Folkert J. ten Cate

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  1. Attila Nemes
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  2. Tamás Forster
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  3. Marcel L. Geleijnse
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  4. Osama I. I. Soliman
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  5. Folkert J. ten Cate
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  6. Miklós Csanády
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Correspondence to Attila Nemes.

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Nemes, A., Forster, T., Geleijnse, M.L. et al. Prognostic value of coronary flow reserve and aortic distensibility indices in patients with suspected coronary artery disease. Heart Vessels 23, 167–173 (2008). https://doi.org/10.1007/s00380-007-1026-5

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  • DOI: https://doi.org/10.1007/s00380-007-1026-5

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