Comparison of relative coronary Doppler flow velocity reserve to stress myocardial perfusion imaging in patients with coronary artery disease

Amr El-Shafei, Ravi Chiravuri, Miodrag M. Stikovac, Mahmoud A. El-Badry, Thomas J. Donohue, Richard G. Bach, Frank V. Aguirre, Eugene A. Caracciolo, Saad Bitar, Thomas L. Wolford, D. Douglas Miller, Morton J. Kern

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16 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)193-201
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume53
Issue number2
DOIs
StatePublished - Jun 23 2001
Externally publishedYes

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Keywords

  • Coronary blood flow
  • Coronary vasodilatory reserve
  • Stress perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

El-Shafei, A., Chiravuri, R., Stikovac, M. M., El-Badry, M. A., Donohue, T. J., Bach, R. G., Aguirre, F. V., Caracciolo, E. A., Bitar, S., Wolford, T. L., Douglas Miller, D., & Kern, M. J. (2001). Comparison of relative coronary Doppler flow velocity reserve to stress myocardial perfusion imaging in patients with coronary artery disease. Catheterization and Cardiovascular Interventions, 53(2), 193-201. https://doi.org/10.1002/ccd.1147