Long-term prognostic role of coronary flow velocity reserve in patients with aortic valve stenosis - insights from the SZEGED Study

P>Introduction: Coronary flow velocity reserve (CFR) is markedly reduced in severe aortic valve stenosis (AS). Independent prognostic value of pulsed-wave Doppler echocardiography-derived CFR was seen in a variety of diseases. However, the prognostic significance of CFR by pulsed-wave Doppler echocardiography has never been evaluated in patients with AS. Methods: A total of 49 AS patients (mean age: 63 +/- 9 years, 26 men) were enrolled in this prospective follow-up study; they all had undergone standard transthoracic Doppler-echo study, coronary angiography and dipyridamole stress transoesophageal echocardiography as CFR measurement. Results: During a mean follow-up of 82 +/- 38 months, 18 patients suffered cardiovascular death and one patient had non-fatal stroke. Other two patients underwent reoperation of dysfunctional prosthetic aortic valve. Using receiver operator curve (ROC) analysis, CFR < 2 center dot 13 had the highest accuracy in predicting cardiovascular outcome (sensitivity 90%, specificity 46%, area under the curve 66%, P = 0 center dot 02). By univariable analysis, diabetes mellitus, hypertension, presence of coronary artery disease and lower CFR were significant predictors of cardiovascular morbidity and mortality. Multivariable regression analysis showed that only lower CFR [hazard ratio (HR) 1 center dot 67, 95% CI of HR: 1 center dot 05-4 center dot 29, P < 0 center dot 05] was independent predictor of cardiovascular outcome. Discussion: Long-term prognostic significance of CFR for prediction of cardiovascular morbidity and mortality has been demonstrated during a 9-year follow-up in patients with AS. Despite a relatively small number of patients were followed, CFR was found to be an independent predictor for future cardiovascular events in AS patients.