TY - JOUR
T1 - Comparison of relative coronary Doppler flow velocity reserve to stress myocardial perfusion imaging in patients with coronary artery disease
AU - El-Shafei, Amr
AU - Chiravuri, Ravi
AU - Stikovac, Miodrag M.
AU - El-Badry, Mahmoud A.
AU - Donohue, Thomas J.
AU - Bach, Richard G.
AU - Aguirre, Frank V.
AU - Caracciolo, Eugene A.
AU - Bitar, Saad
AU - Wolford, Thomas L.
AU - Douglas Miller, D.
AU - Kern, Morton J.
PY - 2001
Y1 - 2001
N2 - To compare relative coronary artery vasodilator reserve (rCVR = CVR target/CVR reference) to myocardial perfusion stress imaging, 48 patients with coronary artery stenoses (61% ±1 6%; mean, ± SD; range, 30%-91%) had measurements of target and reference vessel CVR (Doppler-tipped guidewire). RCVR was computed and compared to stress 201thallium or 99mtechnetium-sestamibi myocardial tomography. Compared to 24 patients with negative stress imaging studies, 24 patients with positive stress studies had angiographically more severe stenoses (74% ± 13% vs. 44% ± 24%; P = 0.0005) with lower CVR target (1.68 ± 0.55 vs. 2.46 ± 0.74; P = 0.002) and lower rCVR (0.72 ± 0.22 vs. 1.0 ± 0.26; P < 0.003). Based on receiver-operator characteristic (ROC) cut points (CVR > 1.9; rCVR > 0.75), compared to CVR, rCVR had similar agreement (Kappa 0.54 vs. 0.50), sensitivity (63% vs. 71%), specificity (88% vs. 83%), and positive predictive value (83% vs. 81%) with myocardial perfusion tomography. A concordant CVR target/rCVR only slightly increased sensitivity, specificity, and positive predictive values (77%, 90%, and 87%, respectively). Although rCVR, like CVR, correlates with stress myocardial perfusion imaging results, rCVR did not have significant incremental prognostic value over CVR alone for myocardial perfusion imaging. However, rCVR does provide additional information regarding the status of the microcirculation in patients with coronary artery disease and complements the CVR for lesion assessment.
AB - To compare relative coronary artery vasodilator reserve (rCVR = CVR target/CVR reference) to myocardial perfusion stress imaging, 48 patients with coronary artery stenoses (61% ±1 6%; mean, ± SD; range, 30%-91%) had measurements of target and reference vessel CVR (Doppler-tipped guidewire). RCVR was computed and compared to stress 201thallium or 99mtechnetium-sestamibi myocardial tomography. Compared to 24 patients with negative stress imaging studies, 24 patients with positive stress studies had angiographically more severe stenoses (74% ± 13% vs. 44% ± 24%; P = 0.0005) with lower CVR target (1.68 ± 0.55 vs. 2.46 ± 0.74; P = 0.002) and lower rCVR (0.72 ± 0.22 vs. 1.0 ± 0.26; P < 0.003). Based on receiver-operator characteristic (ROC) cut points (CVR > 1.9; rCVR > 0.75), compared to CVR, rCVR had similar agreement (Kappa 0.54 vs. 0.50), sensitivity (63% vs. 71%), specificity (88% vs. 83%), and positive predictive value (83% vs. 81%) with myocardial perfusion tomography. A concordant CVR target/rCVR only slightly increased sensitivity, specificity, and positive predictive values (77%, 90%, and 87%, respectively). Although rCVR, like CVR, correlates with stress myocardial perfusion imaging results, rCVR did not have significant incremental prognostic value over CVR alone for myocardial perfusion imaging. However, rCVR does provide additional information regarding the status of the microcirculation in patients with coronary artery disease and complements the CVR for lesion assessment.
KW - Coronary blood flow
KW - Coronary vasodilatory reserve
KW - Stress perfusion imaging
UR - http://www.scopus.com/inward/record.url?scp=0034995543&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0034995543&partnerID=8YFLogxK
U2 - 10.1002/ccd.1147
DO - 10.1002/ccd.1147
M3 - Article
C2 - 11387603
AN - SCOPUS:0034995543
SN - 1522-1946
VL - 53
SP - 193
EP - 201
JO - Catheterization and Cardiovascular Interventions
JF - Catheterization and Cardiovascular Interventions
IS - 2
ER -