Reversible wall motion abnormalities do not predict long-term mortality if coronary flow reserve is accounted for: A 15-year contrast stress-echo study.

BACKGROUND

Stress echocardiography (SE) is widely used to detect myocardial ischaemia in the scenario of chronic coronary syndromes (CCS). Despite that, the prognostic value of SE has been rarely assessed. We aim to establish whether the presence of reversible wall motion abnormalities (RWMA), remains independently associated with long-term mortality when considering myocardial perfusion (MP) and Doppler coronary flow velocity reserve in the left anterior descending artery (CFVR-LAD).

METHOD: 1002 subjects who underwent Dipyridamole contrast SE, for suspected CCS, between 2007 and 2012 at the Parma University Hospital were enrolled. The endpoint is all-cause mortality. The probability of survival was calculated using the Kaplan-Meier method and event-rate curves were compared using the log-rank test.

RESULTS

There were 376 deaths (37.5%) during a median follow-up of 13.8 years. Mean age was 66 ± 11 years, females represented 38%, 32% had known CCS. SE results showed RWMA in 17.5%, reversible MP abnormalities in 26.2%, and reduced CFVR-LAD in 42% of the study population. Revascularization within 3 months of the SE was performed in 185 subjects (18.5%). In multivariate Cox proportional hazard analysis, among the SE variables, only CFVR-LAD<2 remained associated with mortality (HR 2.44, 95% CI 1.94-3.5, p < 0.0001).

CONCLUSION

In the setting of CCS patients, CFVR-LAD is the only SE variable maintaining independent association with long-term mortality.