Circulation, Vol 77, 873-885, Copyright © 1988 by American Heart Association
RF Wilson, MR Johnson, ML Marcus, PE Aylward, DJ Skorton, S Collins and CW White
To determine the effects of coronary angioplasty on coronary flow reserve
(CFR), we studied 32 patients before and immediately after single-vessel
coronary angioplasty and 31 patients evaluated late after angioplasty (7.5
+/- 1.2 months, mean +/- SEM). The geometry (percent area stenosis and
minimal cross-sectional area) of each lesion was determined by quantitative
coronary angiography (Brown/Dodge method) and the integrated optical
density was measured by videodensitometry. CFR was measured with a No. 3F
coronary Doppler catheter placed immediately proximal to the lesion and a
maximally vasodilating dose of intracoronary papaverine. The translesional
pressure gradient was obtained in all lesions before and immediately after
angioplasty and in 18 of 31 vessels late after angioplasty. CFR immediately
after angioplasty returned to normal levels (greater than 3.5 peak/resting
velocity ratio) in 14 of 31 patients and was improved, although not
normalized, in the remaining 17 patients. CFR immediately after dilation
was not significantly correlated with any of the angiographic variables of
arterial stenosis nor the resting pressure gradient. Moreover, the pressure
gradient and absolute distal coronary pressure at peak hyperemia were not
significantly different in vessels with normal and those with abnormal flow
reserve immediately after dilation, suggesting that the residual stenosis
did not significantly limit hyperemia. Late after angioplasty, however, a
significant relationship emerged between CFR and all four indexes of
residual arterial stenosis (percent area stenosis r = .70, p less than .01;
minimum arterial cross- sectional area r = .70, p less than .01; integrated
optical density r = .60, p less than .01; and translesional pressure
gradient r = .77, p less than .01). Furthermore, in the absence of
restenosis, CFR eventually normalized in all patients. These findings
demonstrate that in one-half of patients there is a transient reduction in
coronary flow reserve immediately after angioplasty. In the absence of
restenosis, coronary flow reserve later normalizes. Consequently,
measurements of coronary flow reserve immediately after angioplasty may not
reflect the eventual success of the procedure in removing physiologic
obstruction to coronary blood flow.
ARTICLES
The effect of coronary angioplasty on coronary flow reserve
Department of Internal Medicine, University of Iowa, Iowa City.
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