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Open Access Research

The impact of aging and atherosclerotic risk factors on transthoracic coronary flow reserve in subjects with normal coronary angiography

Maurizio Galderisi16*, Fausto Rigo2, Sonia Gherardi3, Lauro Cortigiani4, Ciro Santoro1, Rosa Sicari5 and Eugenio Picano5

Author Affiliations

1 Division of Cardioangiology, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy

2 Division of Cardiology, “Dell’Angelo” Hospital, Mestre, Italy

3 Division of Cardiology, Bufalini Hospital, Cesena, Italy

4 Division of Cardiology, Lucca Hospital, Lucca, Italy

5 Institute of Clinical Physiology, National Council of Research, Pisa, Italy

6 Department of Clinical and Experimental Medicine, Echo Lab, Cardioangiology Unit, Edificio 1, Federico II University Hospital, Via S. Pansini 5, Naples, 80131, Italy

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Cardiovascular Ultrasound 2012, 10:20  doi:10.1186/1476-7120-10-20

Published: 14 May 2012

Abstract

Age may affect coronary flow reserve (CFR) especially in subjects with atherosclerotic risk factors (ARFs). The aim of this prospective, multicenter, observational study was to determine the effects of aging on CFR in patients with normal epicardial coronary arteries and ARFs. Three-hundred-thirty-five subjects (mean age = 61 years) with at least one ARF but normal coronary angiography underwent high-dose dipyridamole stress-echo with Doppler evaluation of left anterior descending artery. CFR was calculated as the ratio between hyperemic and resting coronary diastolic peak velocities. Patients were divided in age quartiles. CFR was progressively reduced with aging (1st quartile: 3.01 ± 0.69, 4th quartile: 2.39 ± 0.49, p < 0.001). This was mainly due to a gradual increase of resting velocities (1st quartile = 26.3 ± 6.1 cm/s, 4th quartile = 30.2 ± 6.4 cm/s, p < 0.001) while the reduction of hyperemic velocities remained unaffected (1st quartile = 77.7 ± 18.9 cm/s, 4th quartile = 70.9 ± 18.4 cm/s, NS). When age quartiles and ARFs were entered into a regression model, third and fourth age quartile (p < 0.0005 and p < 0.0001 respectively), left ventricular mass index (p < 0.0001), diastolic blood pressure (p < 0.001), total cholesterol (p < 0.002), fasting blood glucose (p < 0.01) and male gender (p < 0.05) were independent determinants of CFR in the whole population. Aging reduces coronary flow reserve in patients with angiographically normal coronary arteries due to a gradual increase of resting coronary flow velocity. CFR is also affected by atherosclerotic risk factors and left ventricular hypertrophy.

Keywords:
Coronary flow reserve; Aging; Atherosclerotic risk factors; Transthoracic Doppler echocardiography; Stress echocardiography.