Copyright © 1996 by the European Society of Cardiology.
© 1996 The European Society of Cardiology
Failure to demonstrate myocardial ischaemia in patients with angina and normal coronary arteries. Evaluation by continuous coronary sinus pH monitoring and lactate metabolism
,
*National Heart and Lung Institute London, U.K.
George's Hospital London, U.K.
Instituto do Corac
o Sao Paulo, Brazil
Istituto H San Raffaele Roma, Italy
revised 13 November 1995; accepted 18 December 1995.
Giuseppe M. C. Rosano, Department of Cardiology, Istituto H San Raffaele, via Elio Chianesi 33, 00144 Roma, Italy
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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