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European Heart Journal 2001 22(18):1725-1732; doi:10.1053/euhj.2000.2587
Copyright © 2001 by the European Society of Cardiology.
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The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study

J.J Pieka,f1, E Boersmab, M Voskuila, C di Marioc, E Schroederd, C Vrintse, P Probstf, B de Bruyneg, C Haneth, E Flecki, M Haudej, E Vernak, V Voudrisl, H Geschwindm, H Emanuelssonn, V Mühlbergero, H.O Peelsp and P.W Serruys, on behalf of the DEBATE study groupb

a Academical Medical Center, Amsterdam, The Netherlands
b Thoraxcenter Rotterdam, The Netherlands
c Centro Curore Columbus, Milano, Italy
d Clinique Universitaire de Mont-Godinne, Yvoir, Belgium
e Universitair Ziekenhuis Antwerpen, Belgium
f Kardiologische Universitätsklinik Wien, Austria
g Onze Lieve Vrouwe Kliniek Aalst, Belgium
h Clinique Universitaires de Saint-Luc, Brussel, Belgium
i Deutsches Herzzentrum Berlin, Germany
j Universitåt Essen, Germany
k Ospedale di Circolo, Varese, Italy
l Onassis Cardiac Surgery Center, Athens, Greece
m Université Paris XII Val de Marne, La Creteil, France
n Sahlgrenska Hospital Göteborg, Sweden
o Universitätsklinik fur Innere Medizin Innsbrück, Austria
p Academisch Ziekenhuis Groningen, The Netherlands

revised December 19, 2000; accepted December 20, 2000

Abstract

Background There are limited data regarding the immediate and long-term effect of balloon angioplasty on the coronary flow reserve evaluated in a multicentre setting.

Methods and Results A total of 86 patients with one-vessel disease and normal left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis <35%) and at 6-month follow-up. Coronary flow reserve was assessed with a Doppler guide wire. A low coronary flow reserve (≤2·5) after PTCA, due to an increased baseline blood flow velocity, was encountered in 42 of the 86 patients (49%). Recurrence of angina and target lesion revascularization were more frequent in these patients than in patients with a coronary flow reserve >2·5 (46% vs 23% and 36% vs 16%, respectively;P<0·05) due to a trend towards restenosis (29% vs 16%;P=0·15) or a low coronary flow reserve at follow-up due to persistent elevated baseline blood flow velocity. Patients without restenosis showed a decrease or increase of coronary flow reserve during follow-up, determined by alterations of hyperaemic blood flow velocity.

Conclusions Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve >2·5. This patient group consists of patients prone to develop restenosis, while other patients are characterized by a persistently low coronary flow reserve, probably secondary to disturbed autoregulation and/or diffuse mild coronary atherosclerosis. Coronary flow reserve alterations in patients without restenosis were related to changes in hyperaemic blood flow velocity, suggesting that this phenomenon relates to epicardial remodelling.

Key Words: Angiography • coronary stenosis • angioplasty • Doppler flow • remodelling

f1 Correspondence: Jan J. Piek, MD, Department of Cardiology, B2-108, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.


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