Incremental Value of Transthoracic Doppler Echocardiography-Assessed Coronary Flow Reserve in Patients With Suspected Myocardial Ischemia Undergoing Myocardial Perfusion Scintigraphy

Li Ming Gan, Sara Svedlund, Ann Wittfeldt, Charlotte Eklund, Sinsia Gao, Göran Matejka, Anders Jeppsson, Per Albertsson, Elmir Omerovic, Amir Lerman

Research output: Contribution to journalArticle

8 Scopus citations


BACKGROUND: Adenosine-assisted transthoracic Doppler-derived coronary flow reserve (TDE-CFR) reflects coronary vascular function. The prognostic and incremental value of left anterior descending coronary artery TDE-CFR above myocardial perfusion scintigraphy in patients with suspected myocardial ischemia has not yet been studied.

METHODS AND RESULTS: Three hundred seventy-one patients (mean age, 62.3±8.7 years; 46.8% males) referred to myocardial perfusion scintigraphy attributed to suspected myocardial ischemia were included in the study. The TDE-CFR result was blinded to the referring physician. Patients were followed up regarding major cardiovascular events, defined as cardiovascular death, myocardial infarction, or acute revascularization during a median follow-up time of 4.5 years. A TDE-CFR value of ≤2.0 was considered reduced. Major cardiovascular events occurred during follow-up in 60 patients (16.2%). A reduced TDE-CFR was detected in 76 patients (20.5%). Patients with reduced TDE-CFR had an event rate of 36.8% compared to 10.8% in patients with normal TDE-CFR (unadjusted hazard ratio, 4.63; 95% CI, 2.78-7.69; P<0.001). In a multivariate model, TDE-CFR remained a significant independent predictor of major cardiovascular events. The major cardiovascular events rate was 7.5% in patients without myocardial perfusion scintigraphy-detected myocardial ischemia and normal TDE-CFR (n=200), 24.2% in patients without ischemia but with reduced TDE-CFR (n=33), and 46.5% in patients with both myocardial perfusion scintigraphy-detected myocardial ischemia and a reduced TDE-CFR (n=43; P<0.001).

CONCLUSIONS: Coronary microvascular dysfunction, as determined by TDE-CFR, is a strong independent predictor of cardiovascular events and adds incremental prognostic value compared with myocardial perfusion scintigraphy. The current study supports routine assessment of CFR in patients with suspected ischemic heart disease.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Issue number4
StatePublished - Apr 18 2017



  • adenosine
  • coronary blood flow reserve
  • echocardiography
  • myocardial perfusion imaging
  • prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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