Circulation, Vol 89, 2150-2160, Copyright © 1994 by American Heart Association
DD Miller, TJ Donohue, LT Younis, RG Bach, FV Aguirre, MD Wittry, HM Goodgold, BR Chaitman and MJ Kern
BACKGROUND: The physiological assessment of angiographically
intermediate-severity stenoses remains problematic. Functional measurements
of poststenotic intracoronary Doppler coronary flow reserve can be
performed in humans but have not been correlated with hyperemic myocardial
perfusion imaging or angiographic data in this patient population. METHODS
AND RESULTS: Thirty-three patients undergoing diagnostic quantitative
coronary angiography (QCA) for assessment of intermediate-severity coronary
artery disease (mean QCA percent diameter stenosis, 56 +/- 14%) were
studied. Proximal and distal poststenotic Doppler coronary flow velocities
were measured (left anterior descending coronary artery, 16; right coronary
artery, 10; left circumflex artery, 7 patients) before and during peak
maximal hyperemia with intracoronary adenosine (8 to 12 micrograms).
Intravenous pharmacological stress (adenosine, 20 patients; dipyridamole,
13 patients) 99mTc-sestamibi tomographic perfusion imaging was performed
within 1 week of coronary flow-velocity studies. kappa statistics were
calculated to measure the strength of correlation among coronary flow
velocities, perfusion imaging data, and QCA results. QCA stenosis severity
(abnormal, > or = 50% diameter stenosis) and poststenotic Doppler
coronary flow reserve (ratio of abnormal distal hyperemic to basal flow,
< or = 2.0) were correctly correlated in 20 of 27 patients (74%; kappa =
.48). QCA stenosis severity and 99mTc-sestamibi imaging (abnormal if one or
more reversible myocardial segments were present in the poststenotic zone)
were correlated in 28 of 33 patients (85%; kappa = .63). 99mTc-sestamibi
imaging results agreed with the basal (nonhyperemic) proximal-to-distal
velocity ratio (normal, < 1.7) in 15 of 31 patients (48%; kappa = .17).
The strongest correlation occurred between hyperemic distal flow-velocity
ratio measurements and 99mTc-sestamibi perfusion imaging results in 24 of
27 patients (89%; kappa = .78). All 14 patients with abnormal distal
hyperemic flow-velocity values had corresponding reversible 99mTc-
sestamibi tomographic defects. More reversibly hypoperfused segments were
present in patients with abnormal poststenotic hyperemic flow- velocity
ratios (abnormal, 2.4 +/- 0.7 segments; normal, 0.6 +/- 1.0 segments; P
< .05). The number of poststenotic myocardial 99mTc- sestamibi perfusion
defects was correlated with the QCA percent cross- sectional area reduction
(P < .02) and with minimal luminal diameter (P < .05) of
intermediate-severity coronary artery stenoses. CONCLUSIONS: Two
technologically diverse functional measures of stenosis severity--
Doppler-derived poststenotic hyperemic intracoronary flow reserve and
vasodilator stress 99mTc-sestamibi myocardial perfusion imaging--are highly
(89%) correlated. The physiological assessment of coronary stenoses of
angiographically intermediate severity may be improved by the use of these
techniques.
ARTICLES
Correlation of pharmacological 99mTc-sestamibi myocardial perfusion imaging with poststenotic coronary flow reserve in patients with angiographically intermediate coronary artery stenoses
Department of Internal Medicine, St Louis University Medical Center, MO 63110-0250.
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