Skip Navigation

European Heart Journal 2001 22(18):1725-1732; doi:10.1053/euhj.2000.2587
Copyright © 2001 by the European Society of Cardiology.
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Piek, J.J
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Piek, J.J
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

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.

References

  1. Hodgson JMcB, Riley RS, Most AS, Williams DO. Assessment of coronary flow reserve using digital angiography before and after successful percutaneous transluminal coronary angiography. Am J Cardiol. 1987;60:61–65[ISI][Medline]
  2. Zijlstra F, Reiber JHC, Juilliere Y, Serruys PW. Normalization of coronary flow reserve by percutaneous transluminal coronary angioplasty. Am J Cardiol. 1988;61:55–60[CrossRef][ISI][Medline]
  3. van Liebergen RA, Piek JJ, Koch KT, de Winter RJ, Lie KI. Immediate and long-term effect of balloon angioplasty or stent implantation on the absolute and relative coronary blood flow velocity reserve. Circulation. 1998;20:2133–2140
  4. Nanto S, Kodama K, Hori M. Temporal increase in resting coronary blood flow causes an impairment of coronary flow reserve after coronary angioplasty. Am Heart J. 1992;123:28–36[CrossRef][ISI][Medline]
  5. Wilson RF, Johnson MR, Marcus ML. The effect of coronary angioplasty on coronary flow reserve. Circulation. 1988;77:873–885[Abstract/Free Full Text]
  6. Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Delayed recovery of coronary resistive vessel function after coronary angioplasty. J Am Coll Cardiol. 1993;21:612–621[Abstract]
  7. Kern MJ, Dupouy P, Drury JH. Role of coronary artery lumen enlargement in improving coronary blood flow after balloon angioplasty and stenting: a combined intravascular ultrasound Doppler flow and imaging study. J Am Coll Cardiol. 1997;29:1520–1527[Abstract]
  8. Haude M, Caspari G, Baumgart D, Brennecke R, Meyer J, Erbel R. Comparison of myocardial perfusion reserve before and after coronary balloon predilatation and after stent implantation in patients with postangioplasty restenosis. Circulation. 1996;94:286–297[Abstract/Free Full Text]
  9. Serruys PW, Di Mario C, Piek JJ. Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: The D.E.B.A.T.E. Study (Doppler Endpoints Balloon Angioplasty Trial Europe). Circulation. 1997;96:3369–3377[Abstract/Free Full Text]
  10. Doucette JW, Corl PD, Payne HM. Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation. 1992;85:1899–1911[Abstract/Free Full Text]
  11. Bates ER, McGillem MJ, Beals TJ. Effect of angioplasty induced endothelial denudation compared with medial injury on regional coronary blood flow. Circulation. 1987;76:710–716[Abstract/Free Full Text]
  12. Fischell TA, Bausback KN, McDonald TV. Evidence for altered epicardial coronary artery autoregulation as a cause of distal coronary vasoconstriction after successful percutaneous transluminal coronary angioplasty. J Clin Invest. 1990;86:575–584[ISI][Medline]
  13. Erbel R, Heusch G. Coronary Microembolization. J Am Coll Cardiol. 2000;36:22–24[Free Full Text]
  14. Gnasso A, Carallo C, Irace C. Association between intima-media thickness and wall shear stress in common carotid arteries in healthy male subjects. Circulation. 1996;94:3257–3262[Abstract/Free Full Text]
  15. Chobanian AV. The influence of hypertension and other hemodynamic factors in atherogenesis. Prog Cardiovasc Dis. 1983;26:177–196[CrossRef][ISI][Medline]
  16. Dirksen MT, van der Wal AC, van den Berg FM, van der Loos CM, Becker AE. Distribution of inflammatory cells in atherosclerotic plaques related to the direction of flow. Circulation. 1998;19:2000–2003
  17. Kern MJ, Puri S, Bach RG. Abnormal coronary flow velocity reserve after coronary artery stenting in patients; role of relative coronary reserve to assess potential mechanisms. Circulation. 1999;100:2491–2498[Abstract/Free Full Text]
  18. Anderson HV, Stokes MJ, Leon M, Abu-Halawa SA, Stuart Y, Kirkeeide RL. Coronary artery flow velocity is related to lumen area and regional left ventricular mass. Circulation. 2000;102:48–54[Abstract/Free Full Text]
  19. Serruys PW, de Bruyne B, Carlier S. Randomized comparison of primary and provisional balloon angioplasty guided by flow velocity measurement. Circulation. 2000;102:2930–2937[Abstract/Free Full Text]
  20. Di Mario C, Moses JW, Anderson TJ. Randomized comparison of elective stent implantation and coronary balloon angioplasty guided by online quantitative angiography and intracoronary Doppler. Circulation. 2000;102:2938–2944[Abstract/Free Full Text]
  21. Mintz GS, Popma JJ, Pichard AD. Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. Circulation. 1996;94:35–43[Abstract/Free Full Text]
  22. Dangas G, Mintz GS, Mehran R. Preintervention arterial remodeling as an independent predictor of target-lesion revascularization after nonstent coronary intervention: an analysis of 777 lesions with intravascular ultrasound imaging. Circulation. 1999;99:3149–3154[Abstract/Free Full Text]
  23. Narins CR, Holmes DR Jr, Topol EJ. A call for provisional stenting: the balloon is back. Circulation. 1998;97:1298–1305[Free Full Text]
  24. Cantor WJ, Peterson ED, Popma JJ. Provisional stenting strategies: systematic overview and implications for clinical decision-making. J Am Coll Cardiol. 2000;36:1142–1151[Abstract/Free Full Text]
  25. Lafont A, Dubois-Rande JL, Steg PG. The French randomized optimal stenting trial: a prospective evaluation of provisional stenting guided by coronary velocity reserve and quantitative coronary angiography. J Am Coll Cardiol. 2000;36:404–409[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
R. Seabra-Gomes
Is there a future for coronary physiological evaluation in clinical decision making?
Eur. Heart J., September 2, 2001; 22(18): 1633 - 1635.
[PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (4)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Piek, J.J
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Piek, J.J
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?