Intracoronary Doppler Assessment of Moderate Coronary Artery Disease

Autor: Lawrence I. Deckelbaum, W. Carter Grinstead, James D. Joye, Sharon J. Balcom, Bernard J. Villegas, Michael W. Cleman, Seth T. Dahlberg, Richard M. Steingart, Yunsheng Ma, Louis I. Heller, Jeffrey A. Leppo, Christopher Cates, Robert Kipperman, Jeffrey J. Popma, Anita Arnold
Rok vydání: 1997
Předmět:
Zdroj: Circulation. 96:484-490
ISSN: 1524-4539
0009-7322
DOI: 10.1161/01.cir.96.2.484
Popis: Background Coronary angiography may not reliably predict whether a stenosis causes exercise-induced ischemia. Intracoronary Doppler ultrasound may enhance diagnostic accuracy by providing a physiological assessment of stenosis severity. The goal of this study was to compare intracoronary Doppler ultrasound with both 201 Tl imaging and coronary angiography. Methods and Results Fifty-five patients with 67 stenotic coronary arteries underwent coronary angiography with intracoronary Doppler ultrasound and had exercise 201 Tl testing within a 1-week period. Coronary flow reserve was measured, and analyses were performed by independent core laboratories. The mean stenosis was 59±12%; 51 of 67 stenoses were intermediate in severity (40% to 70%). A coronary flow reserve 201 Tl defect in 56 of 67 stenoses (agreement=84%; κ=0.67; 95% CI=0.48 to 0.86). In the patients who achieved 75% of their predicted maximum heart rate, the Doppler and 201 Tl imaging data agreed in 46 of 52 stenoses (agreement=88%; κ=0.77; 95%CI=0.57 to 0.97). Scatter was evident when angiography was compared with coronary flow reserve ( r =.43), and the angiogram did not reliably predict the results of the 201 Tl stress test (κ=0.21; agreement=57% to 63%). Conclusions Doppler-derived coronary flow reserve accurately predicts the presence of exercise-induced ischemia on stress 201 Tl imaging, and coronary angiography does not reliably assess the physiological significance of an intermediate coronary stenosis.
Databáze: OpenAIRE
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