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      Functional Assessment of Coronary Arteries by Poststenotic Intravascular Doppler Ultrasound


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          This study sought to delineate the impact of the rate pressure product on intraluminal Doppler velocity measurements and to determine the relation between poststenotic vasodilator reserve and percent luminal obstruction in coronary vessels. Twenty patients with single-vessel coronary disease were studied prior to coronary angioplasty and at follow-up 6 months later. Intracoronary velocity reserve after administration of adenosine was measured distal to the stenosis with a Doppler-tipped guide wire and was compared to quantitative coronary angiography and adenosine myocardial perfusion scintigraphy. The rate pressure product was confirmed as significant covariate (ANCOVA, p < 0.005) of intracoronary Doppler reserve. When normalized to rate pressure product, poststenotic Doppler velocity reserve in stenosed arteries was significantly lower than in patent arteries as classified by quantitative coronary angiography (1.7 ± 0.6 vs. 2.9 ± 0.5, p < 0.001) and perfusion scintigraphy (1.5 ± 0.4 vs. 2.8 ± 0.5, p < 0.001). Normalized Doppler velocity reserve showed a nonlinear but highly significant relation to percent area stenosis [y = 3.0·(1 – exp[0.081 (x – 100)]), p < 0.001]. When normalized Doppler velocity reserve was less than 2.0, coronary disease was identified with 95% specificity and 94% sensitivity in comparison to perfusion scintigraphy. Thus, in coronary arteries poststenotic Doppler reserve and percent area stenosis show a significant nonlinear relation. Doppler velocity reserve when normalized to rate pressure product can be used to characterize the hemodynamic impact of coronary obstructions.

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          Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses.

          The clinical significance of coronary-artery stenoses of moderate severity can be difficult to determine. Myocardial fractional flow reserve (FFR) is a new index of the functional severity of coronary stenoses that is calculated from pressure measurements made during coronary arteriography. We compared this index with the results of noninvasive tests commonly used to detect myocardial ischemia, to determine the usefulness of the index. In 45 consecutive patients with moderate coronary stenosis and chest pain of uncertain origin, we performed bicycle exercise testing, thallium scintigraphy, stress echocardiography with dobutamine, and quantitative coronary arteriography and compared the results with measurements of FFR. In all 21 patients with an FFR of less than 0.75, reversible myocardial ischemia was demonstrated unequivocally on at least one noninvasive test. After coronary angioplasty or bypass surgery was performed, all the positive test results reverted to normal. In contrast, 21 of the 24 patients with an FFR of 0.75 or higher tested negative for reversible myocardial ischemia on all the noninvasive tests. No revascularization procedures were performed in these patients, and none were required during 14 months of follow-up. The sensitivity of FFR in the identification of reversible ischemia was 88 percent, the specificity 100 percent, the positive predictive value 100 percent, the negative predictive value 88 percent, and the accuracy 93 percent. In patients with coronary stenosis of moderate severity, FFR appears to be a useful index of the functional severity of the stenoses and the need for coronary revascularization.

            Author and article information

            J Vasc Res
            Journal of Vascular Research
            S. Karger AG
            December 2000
            10 January 2001
            : 37
            : 6
            : 594-602
            Department of Cardiology, University of Vienna, Austria
            54093 J Vasc Res 2000;37:594–602
            © 2000 S. Karger AG, Basel

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            Page count
            Figures: 3, Tables: 2, References: 36, Pages: 9
            Research Paper

            General medicine,Neurology,Cardiovascular Medicine,Internal medicine,Nephrology
            Intracoronary Doppler ultrasound,Coronary artery disease,Coronary flow reserve,Intravascular Doppler ultrasound,Rate pressure product


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