Assessment of severity of coronary stenoses using a Doppler catheter. Validation of a method based on the continuity equation.

Abstract

The coronary Doppler catheter has been used primarily in the measurement of coronary vasodilator reserve, most often as the ratio of peak to resting velocity in response to an intracoronary dose of papaverine. We have developed a new method based on the continuity equation using a Doppler catheter for the assessment of stenosis severity in the coronary circulation by means of quantitative velocity measurements obtained by complex spectral analysis of the Doppler signal. With this system we have been able to detect a high-velocity stenosis jet in a canine model of coronary stenosis of known cross-sectional area. Using the peak velocity obtained by complex spectral analysis, we found a strong correlation between cross-sectional areas determined by the continuity equation and known cross-sectional areas (r = 0.93, SEE = 0.23 mm2). We also found a strong correlation between the ratio of peak stenosis velocity to proximal vessel velocity and percent diameter and percent area stenosis (r = 0.91 and 0.92, respectively). When the velocity was determined with conventional zero-crossing methods for these parameters, there was no correlation between calculated and known values for cross-sectional area and percent diameter or area stenosis. Measurements of the vasodilator reserve in response to intracoronary papaverine before and after implantation of the stenosis did not correlate with any of the anatomic parameters of stenosis severity regardless of the method of signal analysis (zero-crossing or complex spectral analysis). The measurement of quantitative peak coronary velocity with a Doppler catheter using complex spectral analysis may provide an accurate method for determining the severity of a coronary stenosis.