Clinical significance of coronary flow reserve

Felder, L.; Vassalli, Giuseppe; Vassalli, Fabio; Jiang, Zhihua; Grimm, J; Krayenbuehl, H. P.; Hess, Otto M.

doi:10.1097/00019501-199404000-00011

Cited by 9 publications

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“…Subsequently, coronary flow reserve has been used as a clinical parameter for assessing the functional significance of intermediate coronary stenoses. Three types of stimuli have been used to elicit maximal coronary blood flow in humans: (1) transient coronary occlusion during angioplasty (reactive hyperemia) [4]; (2) pharmacologic agents such as papaverine [5][6][7], adenosine [6][7][8], and dipyridamole [8]; (3) dynamic exercise [9].…”

Section: Introductionmentioning

confidence: 99%

Does the β-Blocker Nebivolol Increase Coronary Flow Reserve?

Togni

Vigorito

Windecker

et al. 2007

Cardiovasc Drugs Ther

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Section: Introductionmentioning

confidence: 99%

Does the β-Blocker Nebivolol Increase Coronary Flow Reserve?

Togni

Vigorito

Windecker

et al. 2007

Cardiovasc Drugs Ther

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Measurement of coronary flow reserve and its role in patient care

Vassalli

Hess

1998

Basic Research in Cardiology

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Coronary anatomy and myocardial blood flow are major determinants of clinical symptomatology and survival in patients with coronary artery disease. While coronary anatomy has been successfully assessed by coronary angiography and intravascular ultrasound imaging, measurements of coronary blood flow are more difficult and their prognostic value has not been definitively evaluated. Measurements of coronary flow reserve (CFR), defined as maximal hyperemic flow divided by resting flow, have been used to assess the functional significance of coronary artery lesions. However, functional assessment of epicardial coronary lesions is limited by several factors, such as diffuse coronary artery disease, small-vessel disease, regional variations in myocardial flow, endothelial dysfunction, and left ventricular hypertrophy. CFR can be measured by several techniques, each one with distinct advantages and limitations, which are discussed in this review. An important distinction is between techniques that measure coronary blood flow (e.g., positron emission tomography) and those that measure blood flow velocity (e.g., Doppler catheters), from which coronary velocity reserve (CVR) is calculated. Although clinical CFR measurements have been possible for over fifteen years, their implementation in patient care has been slow due to several factors including the requirement for a sophisticated technology, the difficult interpretation of CFR results, and the limited knowledge of their prognostic value. While a normal CFR in patients with single vessel coronary disease is associated with a good prognosis, the converse has not been established, i.e., that there is a critical reduction in CFR that requires interventional treatment. A recent study (DEBATE) showed a decrease in the incidence of cardiac events at 6 months after coronary balloon angioplasty in patients with a post-procedural percent diameter stenosis < 35% and a CVR > 2.5. The complex relation between coronary anatomy, myocardial perfusion, and patient outcome have enormous implications for both patient care and health costs, which need to be addressed in future prospective trials.

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Coronary vasomotion during dynamic exercise: Influence of intravenous and intracoronary nicardipine

Kaufmann

Vassalli

Utzinger

et al. 1995

Journal of the American College of Cardiology

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Exercise induces vasoconstriction of stenotic, but vasodilation of normal, coronary vessel segments. Intravenous and intracoronary nicardipine prevent vasoconstriction of stenotic coronary arteries during exercise and exert a significant anti-ischemic effect. The combination of two anti-ischemic drugs, nitroglycerin and nicardipine, has an additive effect on coronary vasomotion that is seen only in the stenotic vessel segment. Thus, the anti-ischemic action of nicardipine is mainly due to a primary effect on coronary vasomotor response rather than to secondary effects such as changes in loading conditions.

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Clinical significance of coronary flow reserve

Cited by 9 publications

References 0 publications

Does the β-Blocker Nebivolol Increase Coronary Flow Reserve?

Does the β-Blocker Nebivolol Increase Coronary Flow Reserve?

Measurement of coronary flow reserve and its role in patient care

Coronary vasomotion during dynamic exercise: Influence of intravenous and intracoronary nicardipine

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