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

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

doi:10.1002/ccd.1147

Cited by 19 publications

(5 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…13,14 Because of the variability of CFR and limitations in patients with multivessel CAD, rCFR is not commonly used. Likewise, rCFR relies on the assumption that the microvascular circulatory response is uniformly distributed among the myocardial beds; thus, rCFR is of no value in patients with myocardial infarction (MI) or left ventricular regional dysfunction or in patients in whom the microcirculatory responses may be heterogeneous (eg, those with myocardial fibrosis or asymmetric hypertrophy).…”

Section: Coronary Flow and Flow Reservementioning

confidence: 99%

Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory

Kern

Lerman²,

Bech³

et al. 2006

Circulation

Self Cite

449

177

View full text Add to dashboard Cite

Abstract-With advances in technology, the physiological assessment of coronary artery disease in patients in the catheterization laboratory has become increasingly important in both clinical and research applications, but this assessment has evolved without standard nomenclature or techniques of data acquisition and measurement. Some questions regarding the interpretation, application, and outcome related to the results also remain unanswered. Accordingly, this consensus statement was designed to provide the background and evidence about physiological measurements and to describe standard methods for data acquisition and interpretation. The most common uses and support data from numerous clinical studies for the physiological assessment of coronary artery disease in the cardiac catheterization laboratory are reviewed. The goal of this statement is to provide a logical approach to the use of coronary physiological measurements in the catheterization lab to assist both clinicians and investigators in improving patient care.

show abstract

Section: Coronary Flow and Flow Reservementioning

confidence: 99%

Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory

Kern

Lerman²,

Bech³

et al. 2006

Circulation

Self Cite

449

177

View full text Add to dashboard Cite

show abstract

“…However, the runoff features of the coronary bed distal to the bypass graft anastomosis also play an utmost important role in the determination of coronary flow. Coronary flow and flow reserve are influenced by both the patency of the epicardial parts of the coronary tree and myocardial perfusion as a surrogate of the microvasculature [27,28]. In postinfarction scar tissue, perfusion is decreased compared with normal, viable myocardium.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced cardiac MRI before coronary artery bypass surgery: impact of myocardial scar extent on bypass flow

et al. 2008

View full text Add to dashboard Cite

The aim of the study was to relate the extent of myocardial late gadolinium enhancement (LGE) in cardiac MRI to intraoperative graft flow in patients undergoing coronary artery bypass graft (CABG) surgery. Thirty-three CAD patients underwent LGE MRI before surgery using an inversion-recovery GRE sequence (turboFLASH). Intraoperative graft flow in Doppler ultrasonography was compared with the scar extent in each coronary vessel territory. One hundred and fourteen grafts were established supplying 86 of the 99 vessel territories. A significant negative correlation was found between scar extent and graft flow (r = -0.4, p < 0.0001). Flow in grafts to territories with no or small subendocardial scar was significantly higher than in grafts to territories with broad nontransmural or transmural scar (75 +/- 39 vs. 38 +/- 26 cc min(-1); p < 0.0001). In summary, the extent of myocardial scar as defined by contrast-enhanced MRI predicts coronary bypass graft flow. Beyond the probability of functional recovery, preoperative MRI might add value to surgery planning by predicting midterm bypass graft patency.

show abstract

“…Similar to FFR, accuracy compared with noninvasive testing is also highest in single-vessel disease (75-96%) and slightly lower in MVD and saphenous vein graft lesions (75-83%). (Table 4) [91, 115,117,118,120]. Overall accuracy for myocardial ischemia is 75% with a best cut-off value of 1.9 and is significantly lower compared with FFR and CFR [65].…”

Section: Diagnostic Performance Of Ffr Cfr and Hsrmentioning

confidence: 97%

Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions

Meuwissen¹,

Siebes²,

Chamuleau³

et al. 2009

Interventional Cardiology

View full text Add to dashboard Cite

REVIEWAdequate patient selection for percutaneous coronary intervention is of the greatest importance in order to minimize early and late complications. Therefore, objective evidence for myocardial ischemia is mandatory for the management of patients with coronary artery disease, in particular in multivessel disease and those with intermediate lesions (40-70% diameter stenosis on angiography). The use of sensor-equipped guidewires for the assessment of functional coronary lesion severity has become extensive in the cardiac catheterization laboratory. The hemodynamic indices derived from intracoronary pressure or flow measurements, fractional flow reserve and coronary flow reserve, show a high agreement with noninvasive stress testing. Furthermore, deferral of percutaneous coronary intervention for hemodynamically nonsignificant lesions is associated with a low major adverse cardiac event rate. However, since these indices are based on either intracoronary pressure or flow, they do not investigate the hemodynamics of the coronary circulation entirely, leading to ambiguous outcomes in some cases. Only the use of simultaneously measured intracoronary pressure and flow can comprehensively investigate the separate influences of epicardial and microvascular contributions to coronary flow impairment, thereby minimizing possible misinterpretation of the data.KEYWORDS: angina pectoris n coronary artery disease n coronary flow n microcirculation n percutaneous coronary intervention Rationale for assessment of coronary physiologyWhile coronary angiography is used as the gold standard for documentation of the presence and extent of coronary artery disease, it has its limitations in assessing the functional significance of coronary stenoses [1,2]. Even experienced operators show only moderate results in evaluating the hemodynamic severity of particular stenoses by visual estimation [3]. These limitations of coronary angiography have been consistently documented by functional evaluation using exercise testing or anatomic ana lysis using intravascular ultrasound [1,2]. Pathological studies have shown that the development of most coronary plaques and stenoses starts with so-called positive remodeling, the compensatory enlargement of the outer wall of the artery [4], but will subsequently compromise the vessel lumen. These atherosclerotic plaques will only be detectable on coronary angiography when they have reached a cross-sectional area corresponding to half of the vessel area [2]. Moreover, the athero sclerotic involvement of a diffusely diseased vessel may be underestimated by angio graphy that only visualizes the vessel lumen. Besides the lack of information of the vessel wall, coronary angiography is a 2D imaging technique and generally requires two orthogonal projections for satisfactory visual assessment. Image foreshortening, angulation, tortuosity, vessel overlap and calcifications may hamper adequate geometric evaluation. Even when the geometric dimensions of a stenosis are quantified by computer-assisted ana lysis, th...

show abstract

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

Cited by 19 publications

References 33 publications

Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory

Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory

Contrast-enhanced cardiac MRI before coronary artery bypass surgery: impact of myocardial scar extent on bypass flow

Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions

Contact Info

Product

Resources

About