07-66 - PROGNOSIS VALUE OF TRANSTHORACIC CORONARY FLOW RESERVE IN PATIENTS WITH PROXIMAL LEFT ANTERIOR DESCENDING ARTERY STENOSIS OF INTERMEDIATE SEVERITY - 09/04/08
Meimoun [1],
Jean Christophe Tcheuffa [1],
Virginie Louzoun [1],
Tahar Benali [1],
Smain Sayah [1],
Anne Luycx-Bore [1],
Hamdane Zemir [1],
Christophe Tribouilloy [2]
Voir les affiliationsBackground: Transthoracic coronary flow reserve (TTE-CFR) is a reliable tool to assess the functional significance of left anterior descending artery (LAD) stenosis. However, its prognostic value is less well established.
Objective: This study sought to determine the prognosis value of TTE-CFR > = 2 in medically treated patient with an angiographically intermediate (50 to 70% QCA) proximal LAD stenosis.
Methods: 49 consecutive patients (66 ± 11 years, 71% men, left ventricular ejection fraction 60 ± 6%) with an angiographic intermediate LAD stenosis (54 ± 4% QCA), no previous anterior myocardial infarction, and with a TTE- CFR > = 2 were prospectively included. CFR was measured in the distal part of the LAD after intravenous administration of adenosine (0.14 mg/kg/min within 2 minutes). All patients were treated medically without revascularisation and completed follow up (15 ± 8 months).
Results: The mean CFR was 2.7 ± 0.5. During the follow up period (range 4 to 35 months), 44 patients (90%) remained free of cardiac events and the number of antianginal drugs was not increased. One patient (70 year-old, diabetic, NYHA class III heart failure) died at 14 months (sudden death). No myocardial infarction was observed. An unstable angina occurred in 4 patients and was target-vessel related in 2 cases leading to perform LAD angioplasty at 6 months of follow up. A circumflex angioplasty was performed after 4 months in the third case and the remainder case was left under medical therapy. By the Kaplan-Meier method, at 35 months the percent estimated survival free from death or target vessel-related events was 89 ± 5%.
Conclusion: in patients with proximal LAD stenosis of intermediate severity, non invasive CFR is an interesting prognostic parameter. When TTE-CFR is > = 2 in this setting, deferral of PTCA is associated with low coronary event rate.
© 2007 Elsevier Masson SAS. Tous droits réservés.
Vol 100 - N° 12
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