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PROspective evaluation of coronary FLOW reserve and molecular biomarkers in patients with established coronary artery disease the PROFLOW-trial: cross-sectional evaluation of coronary flow reserve

Artikel i vetenskaplig tidskrift
Författare Inger Haraldsson
Li-Ming Gan
Sara Svedlund
K. Torngren
H. U. Westergren
Björn Redfors
M. Lagerstrom-Fermer
Oskar Angerås
Truls Råmunddal
Petur Petursson
Jacob Odenstedt
Per Albertsson
D. Erlinge
Elmir Omerovic
Publicerad i Vascular Health and Risk Management
Volym 15
Sidor 375-384
ISSN 1176-6344
Publiceringsår 2019
Publicerad vid Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Sidor 375-384
Språk en
Länkar dx.doi.org/10.2147/vhrm.S209003
Ämnesord coronary flow reserve, myocardial infarction, secondary prevention, Doppler echocardiography, dipyridamole stress echocardiography, microvascular dysfunction, prognostic value, angioplasty, association, predicts, outcomes, stenosis, Cardiovascular System & Cardiology
Ämneskategorier Kardiovaskulär medicin

Sammanfattning

Background: Survivors of myocardial infarction (MI) are at high risk of new major adverse cardiovascular events (MACE). Coronary flow reserve (CFR) is a strong and independent predictor of MACE. Understanding the prevalence of impaired CFR in this patient group and identifying risk markers for impaired CFR are important steps in the development of personalized and targeted treatment for high-risk individuals with prior MI. Methods: PROFLOW is a prospective, exploratory, cross-sectional open study. We used information from the SCAAR (Swedish Coronary Angiography and Angioplasty Registry) to identify high-risk patients with a history of type-1 MI. We measured CFR non-invasively in a left anterior descending artery (LAD) using transthoracic Doppler echocardiography. Coronary flow velocity was measured at rest and at maximal flow after induction of hyperemia by intravenous infusion of adenosine (140 mu g/kg/min). Independent predictors of CFR were assessed with multiple linear regression. Results: We included 619 patients. The median age was 69 (IQR 65-73), and 114 (18.4%) were women. Almost one-half of the patients, 285 (46.0%) had the multi-vessel disease, and 147 (23.7%) were incompletely revascularized. The majority were on optimal standard treatment eg ASA (93.1%), statins (90.0%), ACEI/ARB (82.6%) and beta-blockers (80.8%). The majority, 547 (88.4%) had no angina pectoris, and 572 (92.2%) were in NYHA class I. Evaluation of CFR was possible in 611 (98.7%) patients. Mean CFR was 2.74 (+/- 0.79 (mean +/- SD)). A substantial number of patients (39.7%) had CFR <= 2.5. In a multiple linear regression model age, dyslipidemia, smoking, hypertension, body mass index, incomplete revascularization, and treatment with angiotensin receptor blockers were independent predictors of CFR. Conclusion: In this high-risk group of patients with prior MI, the prevalence of impaired CFR was high. Further risk stratification with CFR in addition to traditional cardiovascular risk factors may improve predictive accuracy for future MACE in this patient population.

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