Prestenotic and Poststenotic Flow Measurement to Assess Severity of Coronary Artery Stenosis

Abstract

The purpose of this study was to investigate differences between prestenotic and poststenotic intracoronary Doppler flow velocities and to determine whether these hemodynamic parameters of coronary flow demonstrate a correlation with geometrically measured coronary artery stenosis.

A low-profile (0.018-in.) Doppler angioplasty guidewire capable of providing spectral flow velocity data was used to measure blood flow velocities both proximal and distal of 95 coronary artery stenoses ranging from 15% to 82% in diameter. Percent diameter stenoses were analyzed by quantitative coronary arteriography.

In comparison with prestenotic measurements poststenotic Doppler flow velocities were markedly reduced in coronary artery stenoses with a diameter reduction greater than 50% in quantitative angiography. In stenoses less than 50% no difference between prestenotic and poststenotic parameters of coronary flow could be found. Prestenotic Doppler data demonstrated no correlation to percent diameter stenosis, whereas poststenotic flow data correlated moderately with percent diameter stenosis. Poststenotic Doppler data of stenoses below 50% differed significantly from stenoses above 50%.

In conclusion, intracoronary Doppler flow velocity measurements performed distal to coronary artery stenoses contribute to the evaluation of hemodynamic significances of particular coronary artery stenoses.

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References

1. White CW , Wright CB , Doty DB , et al: Does visual interpretation of the coronary arteriogram predict the physiological importance of a coronary stenosis? N Engl J Med 210:819-824, 1984.

2. Gould KL , Lipscomb K , Hamilton GW : Physiologic basis for assessing critical coronary stenosis. Am J Cardiol 33:87-94, 1974.

3. Harrison DG , White CW , Hiratzka LF , et al: 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 69:1111-1119, 1984.

4. Wilson RF , Marcus ML , White CW : Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. Circulation 75:723-732, 1987.

5. Grondin CM , Dyrda I , Pastemac A , et al: Discrepancies between cineangiographic and postmortem studies. Circulation 49:703-708, 1974.

6. Galbraith JE , Murphy ML , DeSoyza N : Coronary angiogram interpretation: Interobserver variability. JAMA 240:2053-2056, 1978.

7. Zir LM , Miller SW , Dinsomore RE , et al: Interobserver variability in coronary angiography. Circulation 53:627-632, 1978.

8. Arnett EN , Isner JM , Redwood DR , et al: Coronary artery narrowing in coronary heart disease: Comparison of cineangiographic and necropsy findings. Ann Intern Med 91:350-356, 1979.

9. DeRouen TA , Murray JA , Owen W : Variability analysis of coronary arteriograms. Circulation 55:324-328, 1979.

10.

10. Houghton JL , Frank MJ , Carr AA , et al: Relations among impaired coronary flow reserve, left ventricular hypertrophy and thallium perfusion defects in hypertensive patients without obstructive coronary artery disease. J Am Coll Cardiol 15:43-51, 1990.

11.

11. Rosenfield K , Losordo DW , Ramaswamy K , et al: Three-dimensional reconstruction of human coronary and peripheral arteries from images recorded during two-dimensional intravascular ultrasound examination. Circulation 84:1938-1956, 1991.

12.

12. Doucette JW , Corl PD , Payne HM , et al: Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 85:1899-1911, 1992.

13.

13. Segal J , Kern MJ , Scott NA , et al: Alterations of phasic cor Gnary artery flow velocity in humans during percutaneous coronary angioplasty. J Am Coll Cardiol 20:276-286, 1992.

14.

14. Reiber JHC , Kooijman CJ , Slager CJ , et al: Coronary artery dimensions from cineangiograms: Methodology and validation of a computer-assisted analysis procedure. IEEE Trans Med Imaging 3:131-141, 1984.

15.

15. Reiber JHC , Serruys PW , Kooijman CJ , et al: Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantification of coronary cineangiograms. Circulation 71:280-288, 1985.

16.

16. Zijlstra F , van Ommeren J , Reiber JHC , et al: Does quantitative assessment of coronary artery dimensions predict the physiological significance of a coronary stenosis? Circulation 75:1154-1161, 1987.

17.

17. Reiber JHC , Kooijman CJ , den Boer A , et al: Assessment of dimensions and image quality of coronary contrast catheters from cineangiograms. Cath Cardiovasc Diagn 11:521-531, 1985.

18.

18. Serruys PW , Julliere Y , Zijlstra F , et al: Coronary blood flow velocity during percutaneous transluminal coronary angioplasty as a guide for assessment of the functional result. Am J Cardiol 61:253-259, 1988.

19.

19. Wilson RF , Laughlin DE , Ackell PH , et al: Transluminal, subselective measurement of coronary artery blood flow velocity and vasodilatator reserve in man. Circulation 72:82-92, 1985.

20.

20. Tadaoka S , Kagiyama M , Hiramatsu O , et al: Accuracy of a 20 MHz Doppler catheter coronary velocimeter for measurement of coronary blood flow velocity. Cathet Cardiovasc Diagn 12:205-213, 1990.

21.

21. Ofili EO , Kern MJ , Labovitz AJ , et al: Analysis of coronary blood flow velocity dynamics in angiographically normal and stenosed arteries before and after endolumen enlargement by angioplasty. J Am Coll Cardiol 21:308-316, 1993.

22.

22. Ofili EO , Labovitz AJ , Kern MJ : Coronary flow velocity in normal and diseased arteries. Am J Cardiol 71:3D-9D, 1993.

23.

23. Segal J : Applications of coronary flow velocity during angioplasty and other coronary interventional procedures. Am J Cardiol 71:17D-25D, 1993.

24.

24. Kern MJ , Donohue TJ , Aguirre FV , et al: Assessment of angiographically intermediate coronary artery stenosis using the Doppler Flowire. Am J Cardiol 71:26D-33D, 1993.

25.

25. Serruys PW , Di Mario C , Meneveau N , et al: Intracoronary pressure and flow velocity with sensortip guidewires: A new methodologic approach for assessment of coronary hemodynamics before and after coronary interventions. Am J Cardiol 71:41D-53D, 1993.

26.

26. Anderson HV , Kirkeeide RL , Stuart Y , et al: Coronary artery flow monitoring following coronary interventions. Am J Cardiol 71:62D-69D, 1993.

27.

27. Di Mario C , Meneveau N , Gil R , et al: Maximal blood flow velocity in severe coronary stenoses measured with a Doppler guidewire. Limitations for the application of the continuity equation in the assessment of stenosis severity. Am J Cardiol 71:54D-61D, 1993.