Long-term prognostic role of coronary flow velocity reserve in patients with aortic valve stenosis – insights from the SZEGED Study Attila Nemes, Erika Bala ´zs, Miklo ´s Csana ´dy and Tama ´s Forster 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Gyo¨rgyi Clinical Center, University of Szeged, Szeged, Hungary Correspondence Attila Nemes, 2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent- Gyo¨rgyi Clinical Center, University of Szeged, H-6720 Szeged, Kora ´nyi fasor 6, PO Box 427, Hungary E-mail: nemes@in2nd.szote.u-szeged.hu Accepted for publication Received 24 March 2009; accepted 20 July 2009 Key words echocardiography; morbidity; mortality; perfusion; predictive value; prognosis; valvular Summary Introduction: Coronary flow velocity reserve (CFR) is markedly reduced in severe aortic valve stenosis (AS). Independent prognostic value of pulsed-wave Doppler echocardiography-derived CFR was seen in a variety of diseases. However, the prognostic significance of CFR by pulsed-wave Doppler echocardiography has never been evaluated in patients with AS. Methods: A total of 49 AS patients (mean age: 63 ± 9 years, 26 men) were enrolled in this prospective follow-up study; they all had undergone standard transthoracic Doppler-echo study, coronary angiography and dipyridamole stress transoesopha- geal echocardiography as CFR measurement. Results: During a mean follow-up of 82 ± 38 months, 18 patients suffered cardiovascular death and one patient had non-fatal stroke. Other two patients underwent reoperation of dysfunctional prosthetic aortic valve. Using receiver operator curve (ROC) analysis, CFR <2Æ13 had the highest accuracy in predicting cardiovascular outcome (sensitivity 90%, specificity 46%, area under the curve 66%, P =0Æ02). By univariable analysis, diabetes mellitus, hypertension, presence of coronary artery disease and lower CFR were significant predictors of cardiovascular morbidity and mortality. Multivariable regression analysis showed that only lower CFR [hazard ratio (HR) 1Æ67, 95% CI of HR: 1Æ05–4Æ29, P <0Æ05] was independent predictor of cardiovascular outcome. Discussion: Long-term prognostic significance of CFR for prediction of cardiovascular morbidity and mortality has been demonstrated during a 9-year follow-up in patients with AS. Despite a relatively small number of patients were followed, CFR was found to be an independent predictor for future cardiovascular events in AS patients. Introduction Coronary flow velocity reserve (CFR) is markedly reduced in severe aortic valve stenosis (AS). The impairment of coronary flow reserve in AS probably partially due to atherosclerotic disease (Fallen et al., 1967; Marcus et al., 1982; Julius et al., 1997; Kawamoto et al., 2001; Nemes et al., 2002a; Rajappan et al., 2002; Kume et al., 2004; Carpeggiani et al., 2008; Garcia et al., 2009). In a recent study, CFR impairment has been documented even in patients with aortic valve calcification before valve stenosis develops (Bozbas et al., 2008). Moreover, CFR was found to be similarly decreased in AS patients with and without severe left anterior descending coronary artery (LAD) disease (Nemes et al., 2003). Recently, independent prognostic value of pulsed-wave Doppler-derived CFR was seen in a variety of diseases (Nemes et al., 2005, 2007, 2008a,b, 2009a,b; Rigo et al., 2006a,b, 2007a,b, 2008; Tona et al., 2006; Cortigiani et al., 2007, 2008; Sicari et al., 2008, 2009; Meimoun et al., 2009). The present study was designed to evaluate the prognostic significance of CFR by pulsed-wave Doppler stress echocardiography in patients with AS. Methods Study population Hundreds of patients with suspected coronary artery disease, valvular heart disease or cardiomyopathies were selected prospectively from 1997 to evaluate the clinical usefulness of CFR measurements at the Cardiology Center of University of Clin Physiol Funct Imaging (2009) 29, pp447–452 doi: 10.1111/j.1475-097X.2009.00893.x Ó 2009 The Authors Journal compilation Ó 2009 Scandinavian Society of Clinical Physiology and Nuclear Medicine 29, 6, 447–452 447