Regional coronary blood flow velocity and vasodilator reserve in patients with angiographically normal coronary arteries

Kern, Morton J.; Tatineni, Satyam; Gudipati, Chalapathirao; Aguirre, Frank V.; Ring, Michael E.; Serota, Harvey; Deligönül, Ubeydullah

doi:10.1097/00019501-199009000-00010

Cited by 16 publications

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“…2,3 One likely reason CFR has been used is the poorly understood variations in velocity between individuals, both during rest and under hyperemic conditions. 4,5 In this study, we focused on determinants of resting coronary velocity. We hypothesized from physical principles that resting velocity depends on lumen cross-sectional area, the size of the myocardial bed perfused by the artery (ie, regional left ventricular mass), and resting myocardial perfusion.…”

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confidence: 99%

Coronary Artery Flow Velocity Is Related To Lumen Area and Regional Left Ventricular Mass

et al. 2000

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Background-Coronary flow velocity varies widely between individuals, even at rest. Because of this variation, indices with less apparent deviation, such as the ratio of hyperemic to resting velocity (coronary flow reserve), have been more commonly studied. We tested the hypothesis that the flow continuity principle could be used to model resting coronary flow, and we examined the resulting velocity relationship. Methods and Results-We studied coronary velocity in 59 patients using a Doppler wire to measure resting and hyperemic average peak velocities in the left anterior descending artery. Quantitative techniques were used to calculate lumen cross-sectional area and the lengths of all distal coronary branches. Branch lengths were used to estimate regional left ventricular mass. We then calculated the ratio of lumen area to regional mass (A/m). Regional perfusion was estimated from the double product of heart rate and systolic blood pressure.

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confidence: 99%

Coronary Artery Flow Velocity Is Related To Lumen Area and Regional Left Ventricular Mass

et al. 2000

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“…Regional reserve calculations would still be abnormal (0.8), but the data are less convincing with no "true normal" flow zone. Whether coronary artery disease alone in one region is associated with abnormal coronary flow reserve in multiple remote regions is unknown, In patients with angiographically normal arteries, regional coronary flow reserve is thought to be nearly equal [11,12].…”

Section: Discussionmentioning

confidence: 99%

Part IX: Limitations of translesional pressure and flow velocity for long ostial left anterior descending stenoses

Kern

Donohue

Flynn

et al. 1994

Cathet. Cardiovasc. Diagn.

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Translesional pressure and flow velocity can be used to assess angiographically intermediate or indeterminate lesions. Ostial narrowings and long lesions represent situations that may require both pressure and flow velocity assessment. In patients with hypertension, diabetes mellitus, and chronic renal failure, distally measured absolute and regional coronary reserve values alone may not be helpful in selecting lesions requiring intervention.

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“…This assumption has been challenged [30,31]. However, previous studies of regional CVR from this and other laboratories [12,[32][33][34] suggests that flow reserve is relatively uniformly distributed within Ͻ 10% in patients with normal arteries or after cardiac transplantation. The specificity of rCVR in patients with reduced reference vessel CVR was not significantly greater than in the normal CVR reference subgroups.…”

Section: Study Limitationsmentioning

confidence: 94%

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

El-Shafei¹,

Chiravuri²,

Stikovac³

et al. 2001

Cathet Cardio Intervent

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To compare relative coronary artery vasodilator reserve (rCVR = CVRtarget/CVRreference) to myocardial perfusion stress imaging, 48 patients with coronary artery stenoses (61% +/- 16%; 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 (99m)technetium-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 CVRtarget/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.

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Regional coronary blood flow velocity and vasodilator reserve in patients with angiographically normal coronary arteries

Cited by 16 publications

References 0 publications

Coronary Artery Flow Velocity Is Related To Lumen Area and Regional Left Ventricular Mass

Coronary Artery Flow Velocity Is Related To Lumen Area and Regional Left Ventricular Mass

Part IX: Limitations of translesional pressure and flow velocity for long ostial left anterior descending stenoses

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

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