Feasibility, symptoms, adverse effects and complications associated with non invasive assessment of coronary flow velocity in women with suspected or known coronary artery disease. Experience in 1455

Conclusions Noninvasive assessment of coronary flow velocity reserve (CFVR) with transthoracic echocardiography (TTE) is an increasingly used method to evaluate the effects of epicardial coronary stenosis and coronary microvasculature function. The purpose of this investigation was to analize and review the Cagliari University experience in assessing CFVR with TTE to define the feasibility, safety, adverse event profile, and complications rate of the test in women with and suspected coronary artery disease (CAD) Purpose.Noninvasive assessment of coronary flow velocity reserve (CFVR) with transthoracic echocardiography (TTE) is an increasingly used method to evaluate the effects of epicardial coronary stenosis and coronary microvasculature function. The purpose of this investigation was to analize and review the Cagliari University experience in assessing CFVR with TTE to define the feasibility, safety, adverse event profile, and complications rate of the test in women with and suspected coronary artery disease (CAD). Methods. We evaluated CFVR in the left anterior descending coronary artery(LAD) with TTE during adenosine infusion. The pulsed wave Doppler of blood flow velocity was recorded in the LAD at rest and after maximum vasodilation by adenosine infusion (140 mcg/Kg/min in 5 minutes). We analized 1455 consecutive CFVR TTE studies starting from January 2000 to december 2010. The patients (age: 66.4± 11.9 years,range 14-89 years) were referred for CFVR studies for different reasons: 933(64.1%) for programmed follow up after elective and primary PTCA on LAD, 370 (25,4%) for angina, 11 (0,8%) for hypertrophic cardiomiopathy, 38(2,6%) for hypercholesterolemia, 77(5.3%) for systemic sclerosis, 25 (1.7%) for others reasons. Results. A complete CFVR study was achieved in 1429 pts (feasibility: 98,2%),the test being performed also in the early phase of acute coronary syndrome and in obesity women. In the remaining 26 patients (1.8%) the study was interrupted because of hyperpnea (8), general malaise (8), failure to visualize LAD (2),chest pain without EKG changes (2), nausea and headache (2), chest pain with ischemic EKG (1), hypertensive status (systolic blood pressure 200 mmHg, 1),hypotension (70/50 mmH, 1), caffeine assumption (1). Minor symptoms or adverse effects occurred in 548 pts (38,3%) not requiring test termination: hyperpnea (239,16,7 %), flushing (134,9,4%), chest pain without EKG changes (7%), headache (95,6.6%), minor arrhythmias (3.5 %), chest pain with EKG changes (1.5%). No major complications were observed during all studies. Conclusion. Non invasive assessment of CFVR in LAD by TTE is a very feasible method with very low incidence of adverse events and complications in women with suspected or known CAD. It can be used and safely performed in the evaluation of women with atherosclerotic LAD disease and in a broad spectrum of cardiac disease with microvascular impairment.