LAUSR

Ejection fraction (EF) is a parameter that has traditionally been used for prognostic aims during echocardiography. However, it is known that its prognostic role is accurate only if EF has clearly decreased. So, in the large group of patients who had no prior myocardial infarction, with normal EF but with severe narrowing of main coronary arteries, it is impossible to predict a high risk of adverse coronary events in the near future with transthoracic echocardiography at rest. The aim of the study was to compare prognostic values of coronary flow velocity assessment and EF during transthoracic echocardiography. A prospective cohort study comprises 747 patients (380 males; age 58+13 years) referred for echocardiography. Left side coronary artery (left main - LM, left descending – LAD, and circumflex arteries -LCx) flows were scanned in addition to conventional echocardiography. Cardiac death, nonfatal myocardial infarction (MI), acute coronary syndrome and revascularization were defined as major adverse cardiac events (MACE). The period of follow-up was 3 years. During a median follow-up of 36 months, 192 patients experienced 224 MACE. Twenty-six deaths, 16 non-fatal MI, 2 acute coronary syndromes, 180 revascularizations were observed. EF and maximal velocity in proximal segments of coronary arteries were independents predictors of death/MI/acute coronary syndromes. The maximal velocity had a significantly higher predictive value (p<0.004) in the whole group (Figure 1A) as well as among the patients with near normal/normal EF (Figure 1B, 1C). The maximal velocity had a significantly higher predictive value (p<0.0001) of MACE (Figure 1D). Coronary artery scan assessment had the statistically significantly higher predictive accuracy of MACE in comparison with traditional EF in the whole group and in the subgroups with different degrees of decreasing EF.