[en] The value of quantitative assessment of coronary artery dimensions at the site of the most critical coronary stenosis was assessed by comparison with the correspondent reactive hyperaemia as measured by digital subtraction angiography and with the functional results. Thirty-two coronary lesions were analysed and flow reserve data were obtained in an additional 11 vascular distributions without coronary obstruction in 19 patients. Minimal diameter less than 1.25 mm and minimal area less than 1.5 mm2 at the site of the stenosis best separated vascular distributions with inadequate hyperaemic response from those with sufficient reactive hyperaemia (chi 2 = 19.57; P less than 0.0001). Identification of lesion severity based on videodensitometric percentage area stenosis greater than 70% or percentage diameter stenosis greater than 50% yielded similar but poorer results (respectively chi 2 = 14.53; P less than 0.001 and chi 2 = 10.29; P less than 0.005). Additionally, when visually determined percentage stenosis was compared to the quantitatively assessed value, only a fair correlation was observed (r = 0.74), with visual overestimation of lesion severity by an average of 11.1 +/- 9.8% (mean +/- SD). Reactive hyperaemia in vessels with coronary obstruction could be described from minimal coronary dimensions by a quadratic equation but did not correlate closely in this patient population (r = 0.54 with minimal diameter and r = 0.58 with minimal area).(ABSTRACT TRUNCATED AT 250 WORDS)
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Legrand, Victor ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie
Mancini, G. B.
Le Free, M. T.
Vogel, R. A.
Language :
English
Title :
Clinical Value of Digital Radiographic Coronary Quantification: Comparison with Visual Assessment and Coronary Flow Reserve
Khouri EM, Gregg DE, Lowensohn HS. Flow in the major branches of the left coronary artery during experimental coronary insufficiency in the unanesthetized dog. Circ Res 1968; 29: 99-106.
Gould KL, Lipscomb K, Hamilton GW. Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol 1974; 33: 87-94.
Young DF, Cholvin NR, Roth AC. Pressure drop across artificially induced stenoses in the femoral arteries of dogs. Circ Res 1975; 36: 735-43.
Harrison DG, White CW, Hiratzka LF, Doty DB, Barnes DH, Easthman CL, Marcus ML. The value of lesion cross-sectional area determined by quantitative coronary angiography in assessing the physiologic significance of proximal left anterior descending coronary arterial stenosis. Circulation 1984; 69: 1111-9.
Legrand V, Mancini GBJ, Bates ER, Hodgson JMcB, Aueron FM, Smith JS, Gross MD, Vogel RA. A comparative study of coronary flow reserve, coronary anatomy and the results of radionuclide exercise tests in patients with coronary artery disease. J Am Coll Cardiol 1986; 9: 1022-32.
Legrand V, Hodgson JMcB, Bates ER, Aueron FM, Mancini GBJ, Smith JS, Gross MD, Vogel RA. Abnormal coronary flow reserve and abnormal radionculide exercise tests in patients with normal coronary angiograms. J Am Coll Cardiol 1985; 6: 1245-53.
Hoffman JIE. A critical view of coronary reserve. Circulation 1987; 75: 1-6-1-11.
Klocke FJ. Measurements of coronary flow reserve: defining pathophysiology versus making decision about patient care. Circulation 1987; 76: 1183-9.
Legrand V, Aueron FM, Bates ER, O'Neill WW, Hodgson JMcB, Mancini GBJ, Vogel RA. Reversibility of coronary collaterals and alteration in regional coronary flow reserve following successful angioplasty. Am J Cardiol 1984; 54: 453-4.
Kloner RA, Ganote CE, Jennings RB. The 'no reflow' phenomenon after temporary coronary occlusion in the dog. J Clin Invest 1974; 54: 1496-508.