TY - JOUR
T1 - Prognostic Impact of Coronary Flow Reserve in Patients With Reduced Left Ventricular Ejection Fraction
AU - Joh, Hyun Sung
AU - Shin, Doosup
AU - Lee, Joo Myung
AU - Lee, Seung Hun
AU - Hong, David
AU - Choi, Ki Hong
AU - Hwang, Doyeon
AU - Boerhout, Coen K M
AU - de Waard, Guus A
AU - Jung, Ji-Hyun
AU - Mejia-Renteria, Hernan
AU - Hoshino, Masahiro
AU - Echavarria-Pinto, Mauro
AU - Meuwissen, Martijn
AU - Matsuo, Hitoshi
AU - Madera-Cambero, Maribel
AU - Eftekhari, Ashkan
AU - Effat, Mohamed A
AU - Murai, Tadashi
AU - Marques, Koen
AU - Doh, Joon-Hyung
AU - Christiansen, Evald H
AU - Banerjee, Rupak
AU - Kim, Hyun Kuk
AU - Nam, Chang-Wook
AU - Niccoli, Giampaolo
AU - Nakayama, Masafumi
AU - Tanaka, Nobuhiro
AU - Shin, Eun-Seok
AU - Chamuleau, Steven A J
AU - van Royen, Niels
AU - Knaapen, Paul
AU - Koo, Bon Kwon
AU - Kakuta, Tsunekazu
AU - Escaned, Javier
AU - Piek, Jan J
AU - van de Hoef, Tim P
N1 - Publisher Copyright:
© 2022 The Authors.
PY - 2022/8/2
Y1 - 2022/8/2
N2 - Background Intracoronary physiologic indexes such as coronary flow reserve (CFR) and left ventricular ejection fraction (LVEF) have been regarded as prognostic indicators in patients with coronary artery disease. The current study evaluated the association between intracoronary physiologic indexes and LVEF and their differential prognostic implications in patients with coronary artery disease. Methods and Results A total of 1889 patients with 2492 vessels with available CFR and LVEF were selected from an international multicenter prospective registry. Baseline physiologic indexes were measured by thermodilution or Doppler methods and LVEF was recorded at the index procedure. The primary outcome was target vessel failure, which was a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization over 5 years of follow-up. Patients with reduced LVEF <50% (162 patients [8.6%], 202 vessels [8.1%]) showed a similar degree of epicardial coronary artery disease but lower CFR values than those with preserved LVEF (2.4±1.2 versus 2.7±1.2, P<0.001), mainly driven by the increased resting coronary flow. Conversely, hyperemic coronary flow, fractional flow reserve, and the degree of microvascular dysfunction were similar between the 2 groups. Reduced CFR (≤2.0) was seen in 613 patients (32.5%) with 771 vessels (30.9%). Reduced CFR was an independent predictor for target vessel failure (hazard ratio, 2.081 [95% CI, 1.385-3.126], P<0.001), regardless of LVEF. Conclusions CFR was lower in patients with reduced LVEF because of increased resting coronary flow. Patients with reduced CFR showed a significantly higher risk of target vessel failure than did those with preserved CFR, regardless of LVEF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04485234.
AB - Background Intracoronary physiologic indexes such as coronary flow reserve (CFR) and left ventricular ejection fraction (LVEF) have been regarded as prognostic indicators in patients with coronary artery disease. The current study evaluated the association between intracoronary physiologic indexes and LVEF and their differential prognostic implications in patients with coronary artery disease. Methods and Results A total of 1889 patients with 2492 vessels with available CFR and LVEF were selected from an international multicenter prospective registry. Baseline physiologic indexes were measured by thermodilution or Doppler methods and LVEF was recorded at the index procedure. The primary outcome was target vessel failure, which was a composite of cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization over 5 years of follow-up. Patients with reduced LVEF <50% (162 patients [8.6%], 202 vessels [8.1%]) showed a similar degree of epicardial coronary artery disease but lower CFR values than those with preserved LVEF (2.4±1.2 versus 2.7±1.2, P<0.001), mainly driven by the increased resting coronary flow. Conversely, hyperemic coronary flow, fractional flow reserve, and the degree of microvascular dysfunction were similar between the 2 groups. Reduced CFR (≤2.0) was seen in 613 patients (32.5%) with 771 vessels (30.9%). Reduced CFR was an independent predictor for target vessel failure (hazard ratio, 2.081 [95% CI, 1.385-3.126], P<0.001), regardless of LVEF. Conclusions CFR was lower in patients with reduced LVEF because of increased resting coronary flow. Patients with reduced CFR showed a significantly higher risk of target vessel failure than did those with preserved CFR, regardless of LVEF. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04485234.
KW - Coronary Artery Disease/diagnostic imaging
KW - Coronary Vessels/diagnostic imaging
KW - Fractional Flow Reserve, Myocardial/physiology
KW - Humans
KW - Prognosis
KW - Stroke Volume
KW - Ventricular Function, Left/physiology
U2 - 10.1161/JAHA.122.025841
DO - 10.1161/JAHA.122.025841
M3 - Article
C2 - 35876408
SN - 2047-9980
VL - 11
SP - e025841
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 15
M1 - e025841
ER -