Intracoronary Doppler Assessment of Moderate Coronary Artery Disease

Author:

Heller Louis I.1,Cates Christopher1,Popma Jeffrey1,Deckelbaum Lawrence I.1,Joye James D.1,Dahlberg Seth T.1,Villegas Bernard J.1,Arnold Anita1,Kipperman Robert1,Grinstead W. Carter1,Balcom Sharon1,Ma Yunsheng1,Cleman Michael1,Steingart Richard M.1,Leppo Jeffrey A.1

Affiliation:

1. From Winthrop-University Hospital (L.I.H., R.M.S.), Mineola, NY; St Joseph’s Hospital (C.C.), Atlanta, Ga; Washington Hospital Center (J.P.), Washington, DC; West Haven (Conn) Veterans Administration Hospital (L.I.D.); Allegheny General Hospital (J.D.J.), Pittsburgh, Pa; University of Massachusetts, Worcester (S.T.D., B.J.V., S.B., Y.M., J.A.L.); St Luke’s Hospital (A.A.), Milwaukee, Wis; Galicia Medical Group (R.K.), Wichita, Kan; Methodist Hospital (W.C.G.), Houston, Tex; and Yale University (M.C....

Abstract

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 <1.7 predicted the presence of a stress 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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Physiology (medical),Cardiology and Cardiovascular Medicine

Reference33 articles.

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2. Visual estimates of percent diameter coronary stenosis: “A battered gold standard”

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