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Comparison of relative coronary Doppler flow velocity reserve to stress myocardial perfusion imaging in patients with coronary artery disease
Author(s) -
ElShafei Amr,
Chiravuri Ravi,
Stikovac Miodrag M.,
ElBadry Mahmoud A.,
Donohue Thomas J.,
Bach Richard G.,
Aguirre Frank V.,
Caracciolo Eugene A.,
Bitar Saad,
Wolford Thomas L.,
Miller D. Douglas,
Kern Morton J.
Publication year - 2001
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.1147
Subject(s) - medicine , cardiology , coronary artery disease , perfusion , myocardial perfusion imaging , perfusion scanning , fractional flow reserve , coronary flow reserve , radiology , myocardial infarction , coronary angiography
To compare relative coronary artery vasodilator reserve (rCVR = CVR target /CVR reference ) 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 201 thallium 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 CVR target /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. Cathet Cardiovasc Intervent 2001;53:193–201. © 2001 Wiley‐Liss, Inc.