Circulation, Vol 73, 562-571, Copyright © 1986 by American Heart Association
SE Nissen, JL Elion, DC Booth, J Evans and AN DeMaria
Conventional coronary angiography has significant limitations in
quantifying the severity and functional significance of coronary stenoses.
However, coronary reactive hyperemia is an excellent physiologic indicator
of coronary reserve. Digital subtraction angiography offers the potential
to analyze coronary blood flow dynamics quantitatively. Therefore we
assessed the accuracy of digital angiographic methods to detect and
quantify reductions in coronary flow reserve secondary to stenoses of
varying magnitude in an experimental canine preparation. Studies were
performed in nine anesthetized open- chest dogs with an electromagnetic
flow (EMF) probe and two pneumatic occluders positioned on the left
circumflex coronary artery. One occluder served to induce reactive
hyperemia by temporary total occlusion, while the other served to produce
variable gradations of stenosis. Digital angiography was performed after
the subselective injection of contrast under basal conditions and during
reactive hyperemia. Time-intensity curves were obtained from digital
angiograms for both a coronary and a myocardial region of interest.
Measurements included area under the curve, time to peak contrast, and
contrast disappearance rate. An index of coronary reserve was computed as
the ratio of hyperemic to basal measurements for each of these methods.
Coronary blood flow ranged from 6.5 to 142 ml/min, with hyperemic to basal
EMF flow ratios of 0.80 to 4.2:1. The index derived from contrast decay
rate showed a poor correlation with EMF (r = .34). The correlation between
measurements of time to peak myocardial contrast and coronary blood flow
was r = .68 (y = 0.16 x + 0.97). The area under the time-intensity curve
from a coronary region of interest showed a close correlation with coronary
blood flow (y = 0.91 x + 0.1, r = .86). Thus estimates of coronary reserve
by computer analysis of digital subtraction angiograms can yield
information regarding the physiologic consequences of coronary stenoses.
ARTICLES
Value and limitations of computer analysis of digital subtraction angiography in the assessment of coronary flow reserve
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