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The measurement of coronary flow velocity reserve (CFVR) by transthoracic Doppler echocardiography (TTDE) with invasive intracoronary Doppler flow wire technique (ICD) was validated and the pathologicalfactors which influence CFVR in patients with angiographically normal coronary arteries were analyzed. CFVR was determined successfully in left anterior descending artery (LAD) in 37 of 40 patients with angiographically normal coronary arteries (men 22, women 15, age 20-75 years, mean age 54 ± 12 years). Coronary flow velocity was measured in the distal LAD by TTDE with contrast enhancement at baseline and during intravenous adenosine infusion of 140 μg/kg per min within 48 h after ICD technique. Average peak velocity at baseline (APVb), average peak velocity during hyperemia (APVh) and CFVR determined from TTDE were correlated closely with those from ICD measurements (APVb: y=0. 64x+5. 04, r=0. 86, P＜0. 001;APVh: y=0.63x+14.36, r=0.82, P＜0.001; CFVR: y=0.65x+0.92, r=0.88, P＜0. 001).For CFVR measurements, the mean differences between TTDE and ICD methods were 0. 12 ±0.39. CFVR in patients with history of hypertension was significantly lower than that in patients without history of hypertension (P＜0.05). Intravascular ultrasound (IVUS) was performed in 34patients. Plaque formation was found in LAD by IVUS in 17 (50 %) patients. No significant difference in CFVR was found between the patients without plaque formation (3. 11±0. 49) and those with plaque formation (2. 76±0.53, P=0. 056). It is suggested that TTDE with contrast enhancement provides reliable measurement of APV and CFVR in the distal LAD. The early stage of atherosclerosis could be detected by IVUS, which may be normal in angiography. CFVR is impaired in patients with history of hypertension compared with that in patients without history of hypertension.
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Objective To evaluate the safety of intracoronary Doppler flow measurement using Doppler FloWire Methods and Results A total of 906 patients were examined with intracoronary Doppler using a 0 014″ or a 0 018″ Doppler FloWire For coronary flow reserve measurement, intracoronary injection of adenosine or papaverine was used Of the patients studied, 77 were cardiac transplant recipients, 829 were nontransplant patients, of whom 617 patients underwent diagnostic coronary procedures and 212 had coronary interventions In 27 (2 98%) of 906 patients adverse cardiac events were observed Fifteen (1 66%) of 906 patients developed severe transient bradycardia (asystole or Ⅱ? to Ⅲ? atrioventricular block) after intracoronary administration of adenosine Of which, 14 occurred in RCA and 1 in LAD Nine (0 99%) of 906 patients experienced coronary spasm during the passage of the Doppler wire (5 in RCA, 4 in LAD) Two (0 22%) of 906 patients developed ventricular fibrillation during the procedure Hypotension with bradycardia and ventricular extrasystole each occurred in one (0 11%) of 906 patients The incidence of complication was significantly higher in transplant recipients than in nontransplant patients underwent either diagnostic or interventional procedures (12 99% vs 2 43% vs 0 94%, P
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PurposeTo compare measures of coronary flow reserve by an intracoronary Doppler guide wire with results of dipyridamole emission computed tomographic 201T1/ 99m Tc-sestamibi myocardial imaging(SPECT).MethodsThe coronary blood flow velocity were measured by Cardiometrics Flomap Ⅱ and 0. 014 or 0. 018 inches Doppler flowire in 27 patients (55 arteries) with coronary angiography. 8 patients (19 arteries )without underlying diseases of coronary microvascular lesions were studied as the normal control. The proximal and distal average peak velocity (APV), diastolic/systolic velocity ratio (DSVR), CFR and proximal/distal velocity ratio (P/DVR) were measured. The results were compared with that of SPECT before angiography. ResultsAccording to the CFR measured by Doppler fiowire, the arteries were divided into two groups:Group A, consisted of 33 arteries with CFR > 2.0. Group B consistedof 22 arteries with CFR≤2.0. CFR of group A was significantly higher than that of group B (P< 10 - 7). Among 22 arteries with abnormal CFR, SPECT could detect 16. Among 33 arteries with normal CFR, all arteries except 2 showed normal SPECT. With intracoronary Doppler flowire as reference, the sensitivity and specificity of dipyridamole SPECT were 72.73 % and 93.94 %. With results of dipyridamole SPECT as reference, the sensitivity and specificity of intracoronary Doppler CFR were 88.89% and 83.78%. Their conformability rate was 85.45%.Conclusions In evaluating coronary reserve function, results of dipyridamole SPECT was rather conformable to measures of intracoronary Doppler CFR, but they cannot be replaced each other.
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BACKGROUND: Previous studies of animal and human experiments have shown excellent correlation between true or angiographic stenosis severity and stenosis severity calculated from intracoronary Doppler flow measurements and continuity equation method. However, there remains practical problems to be solved on its clinical application. To minimize these problems, the concept of modified continuity equation method, calculating the percent area stenosis by comparing the maximal in-stenosis flow velocity to the distal reference flow velocity, was introduced and compared with dipyridamole stress thallium-201 SPECT. METHODS: In this prospective study, 102 patients (mean age 57+/-10 years, 69 men, 33 women) with coronary artery stenoses ranging from 23-89% in percent diameter stenosis, who received coronary angiography, dipyridamole stress thallium-201 SPECT, and successful intracoronary flow velocity measurements were included. Modified continuity equation method and distal coronary flow velocity reserve were compared to the result of dipyridamole stress thallium-201 SPECT and quantitative coronary angiography. RESULTS: Measurements of adequate intralesional and stenosis distal flow velocities were successful in 102 out of 106 stenoses (96%). Minimal luminal area and percent area stenosis calculated from modified continuity equation method showed significant correlations with those of quantitative coronary angiography. Modified continuity equation method significantly underestimated the severity of stenosis than quantitative coronary angiography did. The test accuracy in relation to the result of dipyridamole stress thallium-201 SPECT were 91% in modified continuity equation method, 80% in quantitative coronary angiography and 63% in distal coronary flow velocity reserve. CONCLUSION: Application of intracoronary Doppler guide wire and modified continuity equation method appears to provide useful on-site implications for the anatomic and functional assessment of coronary artery stenosis. The modified continuity equation method would be one of the promising concepts for clinical decision making during coronary interventions.
Subject(s)
Animals , Humans , Male , Constriction, Pathologic , Coronary Angiography , Coronary Stenosis , Coronary Vessels , Decision Making , Dipyridamole , Phenobarbital , Prospective Studies , Tomography, Emission-Computed, Single-PhotonABSTRACT
Objective To observe the characteristics of coronary hemodynamics in acute hibernating myocardium (AHM) model by intracoronary doppler guidewire. Methods 13 little domestic Chinese swine were established to the model of AHM by interventional method (closed chest),intracoronary Doppler guidewire were used to measure average peak velocity (APV),diastolic systolic velocity ratio (DSVR) and coronary flow velocity reserve (CFVR) distal to the stenosis in the period of pre model,post model and reperfusion.Then animals were executed,the histomography changes of AHM cells were observed.Results 10 animals (76 92%) were established to the model of AHM successfully,myocardium necrosis were not found under microscopical examination.APV and CFVR distal to the stenosis decreased significantly in AHM model ( P
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BACKGROUND: Measurement of coronary flow velocity in clinical caes contributes to understanding the pathophysiology of coronary circulation. To evaluate the coronary hemodynamics, we analyzed the pattern of coronary flow velocity with a new device consisting of 15Mhz piezoelectric transducer integrated into the tipped 0.018 inch or 0.014 inch flexible, steerable angioplasty guidewire. METHOD: A low profile(0.018 in. or 0.014 in.) Doppler angioplasty guidewire was used to measure the basal blood flow velocity in proximal coronary artery after intracoronary infusion of 200µg nitroglycerine, hyperemic blood flow velocity after intracoronary infusion of adenosine(12µg for LCA, 6µg for RCA). We measured several parameters such as APV (average peak velocity, cm/sec), DSVR(diastolic systolic velocity ratio), MPV(maximal peak velosity, cm/sec), PVI(peak velocity integral, cm), SPVI(systolic peak velocity integral, cm), DSIR(diastolic systolic integral ratio), ASPV(average systolic peak velocity, cm/sec) in basal and hyperemic states. This measurements were made in 17 patients undergoing coronary angiography. RESULTS: 1) APV, ADPV, MPV, in the basal state were higher in LCA than in RCA(32.1±16.6, 40.0±23.6, 57.1±29.0/15.8±9.1, 17.1±10.2, 24.5±20.9cm/sec) and DSVR was also higher in LCA(2.7±2.1/1.4±0.6). But ASPV and SPVI was not different(p>0.05). Significant increases in APV were noted in LCA(32.1±16.6→60.6±17.6cm/sec) and in RCA (15.8±9.1→42.1±15.5cm/sec) after adenosine infusion compared with basal state. DSVR measured in basal state were not statistically different from values in hyperemic state in LCA and RCA(2.7±2.1→2.3±1.7, 1.4±0.6→1.4±0.5, p>0.05). CONCLUSION: The blood flow patterns in both coronary arteries showed different biphasic flow patterns and this finding might be due to the pressure gradient during diastolic phase of both ventricles.