The incremental diagnostic value of coronary flowreserve and left ventricular elastance during high-dose dipyridamole stress echocardiography in patients with normal wall motion at rest

摘要

A "normal" dipyridamole stress echocardiogram by wall motion criteria identifies a subset of patients at low risk of experiencing hard events in the follow-up [1]. The sensitivity for identifying significant coronary artery disease (CAD) is suboptimal, and can be increased by adding coronary flow reserve (CFR) assessment by Doppler echocardio-graphy [2] or myocardial contrast echo [3]. Another possible variable of incremental value over wall motion is the assessment of contractile reserve (CR) via the end-systolic pressure-volume relationship (PVR), which has been used with pacing [4], exercise [5] or dobutamine [6] -not yet with dipyridamole.We prospectively enrolled 111 patients (60 men; age 68, SD10 years) with normal baseline function who underwent dipyridamole (0.84 mg/ kg over 6 min) stress echocardiography with CFR evaluation of LAD by Doppler [7] and CR calculated as peak stress ESP (end-systolic pressure)/ ESV (end-systolic volume) - rest ESP/ESV [6]. All patients underwent quantitative coronary angiography performed independently of test results. Informed consent was obtained from each patient and the study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki as reflected in a priori approval by the institution's human research committee. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology.