Functional Assessment of Coronary Arteries by Poststenotic Intravascular Doppler Ultrasound

Abstract

This study sought to delineate the impact of the rate pressure product on intraluminal Doppler velocity measurements and to determine the relation between poststenotic vasodilator reserve and percent luminal obstruction in coronary vessels. Twenty patients with single-vessel coronary disease were studied prior to coronary angioplasty and at follow-up 6 months later. Intracoronary velocity reserve after administration of adenosine was measured distal to the stenosis with a Doppler-tipped guide wire and was compared to quantitative coronary angiography and adenosine myocardial perfusion scintigraphy. The rate pressure product was confirmed as significant covariate (ANCOVA, p < 0.005) of intracoronary Doppler reserve. When normalized to rate pressure product, poststenotic Doppler velocity reserve in stenosed arteries was significantly lower than in patent arteries as classified by quantitative coronary angiography (1.7 ± 0.6 vs. 2.9 ± 0.5, p < 0.001) and perfusion scintigraphy (1.5 ± 0.4 vs. 2.8 ± 0.5, p < 0.001). Normalized Doppler velocity reserve showed a nonlinear but highly significant relation to percent area stenosis [y = 3.0·(1 – exp[0.081 (x – 100)]), p < 0.001]. When normalized Doppler velocity reserve was less than 2.0, coronary disease was identified with 95% specificity and 94% sensitivity in comparison to perfusion scintigraphy. Thus, in coronary arteries poststenotic Doppler reserve and percent area stenosis show a significant nonlinear relation. Doppler velocity reserve when normalized to rate pressure product can be used to characterize the hemodynamic impact of coronary obstructions.

Comparison of quantitative coronary angiography and first‐pass perfusion magnetic resonance imaging for the detection of an impaired coronary perfusion in nonsevere coronary stenosis

“…Therefore, an impaired coronary perfusion due to predominant microvascular disease would be missed by a strictly morphological‐ or stenosis‐oriented functional evaluation and can only be revealed by a functional evaluation of global coronary perfusion (34). However, in some studies a significant correlation between coronary stenosis and CFVR was found (9, 10). In these studies no data on the prevalence of risk factors for microvascular disease were given.…”

“…Experimental studies have demonstrated that a reduced CFVR indicates hemodynamic significance of a coronary stenosis (6, 7). In clinical studies a good correlation was found between CFVR and coronary diameter stenosis (DS) (8) as well as coronary area stenosis (9, 10). However, other data on the correlation between CFVR and coronary stenosis are contradictory.…”