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European Heart Journal 2000 21(6):466-474; doi:10.1053/euhj.1999.1871
Copyright © 2000 by the European Society of Cardiology.
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Angiographical and Doppler flow-derived parameters for assessment of coronary lesion severity and its relation to the result of exercise electrocardiography

J.J Pieka,f1, E Boersmab, 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 Serruysb

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, Antwerp, Belgium
f Kardiologische Universitätsklinik, Wien, Austria
g Onze Lieve Vrouwe Kliniek, Aalst, Belgium
h Clinique Universitaires de Saint-Luc, Brussels, Belgium
i Deutsches Herzzentrum, Berlin, Germany
j Universitåt Essen, 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 July 9, 1999; accepted July 22, 1999

Abstract

Aims Evaluation of angiographical and intracoronary Doppler-derived parameters of coronary stenosis severity.

Methods and Results A total of 225 patients with one-vessel disease were studied before PTCA and at 6 months follow-up. Exercise electrocardiography was performed to document presence (n=157) or absence (n=138) of an ST segment shift (≥0·1mV). Intracoronary blood flow velocity analysis was performed to determine the proximal/distal flow velocity ratio, the distal diastolic/systolic flow velocity ratio and coronary flow velocity reserve. Receiver operator characteristic curves were calculated to assess the predictive value of these variables compared with the exercise test. The distal coronary flow velocity reserve demonstrated the best linear correlation for both percentage diameter stenosis and minimum lumen diameter (r=0·67 and r=0·66;P<0·01), compared to the diastolic/systolic flow velocity ratio (r=0·19 and r=0·14;P<0·01) and the proximal/distal flow velocity ratio (r=0·03 and r=0·07; not significant). The areas under the curve were 0·84±0·02; 0·82±0·03 and 0·83±0·03 for diameter stenosis, minimum lumen diameter and coronary flow velocity reserve, respectively. Logistic regression analysis revealed that the percentage diameter stenosis or minimum lumen diameter and coronary flow velocity reserve were independent predictors for the result of stress testing.

Conclusions The distal coronary flow velocity reserve is the best intracoronary Doppler parameter for evaluation of coronary narrowings. Angiographical estimates of coronary lesion severity and distal coronary flow velocity reserve are good and independent predictors for the assessment of functional severity of coronary stenosis, emphasizing the complementary role of these parameters for clinical decision making.

Key Words: Angiography, coronary stenosis, intracoronary Doppler, exercise electrocardiography

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

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