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European Heart Journal 1996 17(8):1167-1174;
Copyright © 1996 by the European Society of Cardiology.
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© 1996 The European Society of Cardiology

Assessing coronary stenosis. Quantitative coronary angiography versus visual estimation from cine-film or pharmacological stress perfusion images

M. Gottsauner-Wolf, H. Sochor, D. Moertl, M. Gwechenberger, F. Stochenhuber and P. Probst

University of Vienna, Department of Cardiology Waehringer Guertel, Vienna, Austria

revised 1 June 1995; accepted 7 August 1995.

Dr Michael Gottsauner-Wolf, Universitatsklinik f. Innere Medizin II, Abteiluing f. Kardiologie, Waehringer Guertel 18–20, A. 1090 Vienna, Austria

Abstract

Visual judgment of stenosis severity from cine-film or single-photon emission computed tomographic dipyrida-mole perfusion images was compared to assessment of stenosis severity as measured with digital quantitative coronary angiography. Thirty patients with angiographically verified single-vessel disease underwent dipyridamole thallium stress testing within 90 days of angiography.

RESULTS: A percent diameter stenosis of ≥50%, a percent area stenosis of ≥75% and a stenotic flow reserve of <3·75 measured by quantitative coronary angiography (CMS, version 1·1, Medis Inc.) corresponded to haemodynamically significant stenosis as evaluated by visual estimates from cine-film or perfusion images. Quantitative coronary angiography percent diameter stenosis (51·2% ± 12·6%) correlated closely (r=0·74) but underestimated significantly visual assessment of stenosis severity from cine-film (69·3% ±21·2% p=0·0001). However, quantitative coronary angiography percent area stenosis (74·7% ± 11·7%) more closely reflected visual estimates from cine-film (P=0·19). Quantitative coronary angiography stenotic flow reserve showed the highest positive and negative predictive value regarding visual estimates from cine-film (88%, 86%) or perfusion images (88% 64%) followed by percent diameter stenosis (86% 75% 86% 56%) and percent area stenosis (87% 80% 87% 60%), respectively.

CONCLUSION: Evaluation of coronary lesions by quantitative coronary angiography corresponds closely with visual estimates from cine-film and haemodynamic significance as evaluated by dipyridamole perfusion images. (Eur Heart J 1996; 17: 1167–1174)

Key Words: Coronary disease • coronary angiography • dipyridamole • tomography emission-computed single photon


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