Correlation of pharmacological 99mTc-sestamibi myocardial perfusion imaging with poststenotic coronary flow reserve in patients with angiographically intermediate coronary artery stenoses.

Miller, D. Douglas; Donohue, Thomas J.; Younis, Liwa T.; Bach, Richard G.; Aguirre, Frank V.; Wittry, Mark D.; Goodgold, Henry M.; Chaitman, Bernard R.; Kern, Morton J.

doi:10.1161/01.cir.89.5.2150

Cited by 262 publications

(84 citation statements)

References 41 publications

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“…Adenosine-induced CFVR was assessed 3 times, with Ն2 minutes between measures. Patients with abnormal CFVR (Ͻ2.0) 23 were excluded. Baseline CBF was reestablished, and metabolic vasodilation was induced by 2 minutes of ventricular pacing.…”

Section: Methodsmentioning

confidence: 99%

“…Adenosine-induced CFVR was calculated as the ratio of maximal hyperemic APV to baseline APV, and Ն2.0 was defined as normal. 23 CFVR reproducibility was documented in our laboratory in 88 patients (31 female, 57 male; aged 58.3Ϯ10.1 years), with mean percentage difference of 9.6Ϯ0.9%. Maximal hemodynamic responses to pacing (apart from heart rate) occurred immediately after the cessation of pacing and were used for estimation of maximal hyperemia.…”

Section: Estimation Of Coronary Diameter and Blood Flowmentioning

confidence: 99%

See 1 more Smart Citation

Contribution of Vasodilator Prostanoids and Nitric Oxide to Resting Flow, Metabolic Vasodilation, and Flow-Mediated Dilation in Human Coronary Circulation

et al. 1999

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Background-Endothelial dysfunction is associated with atherosclerosis and may contribute to ischemic syndromes. We assessed the contribution of endothelium-derived nitric oxide (NO) and vasodilator prostanoids to resting blood flow, metabolic vasodilation, and flow reserve in the human coronary circulation. Methods and Results-Coronary hemodynamics were assessed before and after inhibition of vasodilator prostanoids and NO with intracoronary aspirin (acetylsalicylic acid [ASA]) and N

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Section: Methodsmentioning

confidence: 99%

Section: Estimation Of Coronary Diameter and Blood Flowmentioning

confidence: 99%

Contribution of Vasodilator Prostanoids and Nitric Oxide to Resting Flow, Metabolic Vasodilation, and Flow-Mediated Dilation in Human Coronary Circulation

et al. 1999

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“…22 Intracoronary Doppler and dipyridamole scintigraphy have recently been shown to corre'-late better with each other than with angiography in patients with lesions of intermediate severity . 23 Nevertheless, Doppler results may vary with changes in arterial pressure, and this limitation has been the impetus for the recent work on fractional flow reserve, which is based on measurement of the hyperaemic translesional pressure gradient. 24 Determination of fractional flow reserve also requires placement of a guidewire in the coronary artery, and it is not yet a routine clinical tool as it has been used only by a small number of investigators.…”

Section: Newer Diagnostic Methodsmentioning

confidence: 99%

Predicting ischaemic events in the perioperative period: in search of the perfect tool

Tardif

Juneau

1996

Can J Anaesth

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Evaluation of patients with coronary artery disease was for many years relatively straightforward. Angina was recognized when chest pain appeared on exertion and this signified the presence of fixed severe narrowings of epicardial coronary arteries. ~ Standardization of exercise electrocardiographic stress testing led to its widespread clinical use for diagnostic and prognostic purposes. 2 Unfortunately, the syndrome and its assessment later proved to be more complicated. Episodes of myocardial ischaemia without chest pain were recognized and the prognostic importance of silent ischaemia was defined. 3 A form of variant angina occuring primarily at rest and caused by coronary vasospasm was identified. 4 It also became obvious that the pathophysiology of unstable angina and myocardial infarction involved plaque rupture and thrombus formation, and not only vasospasm and clearly not simple progression in the accumulation of atherosclerotic material. 5 The importance of coronary endothelial dysfunction in plaque rupture, platelet adhesion and thrombus fomation also became progressively more apparent. 6 The limitations of electrocardiographic stress testing were also identified, as described in Dr. Yang's review in this issue of the Journal. 7Anatomical and physiological assessment of patients with coronary artery disease Accompanying our better understanding of clinical presentation and pathophysiology w.as the development of many diagnostic tools. Selective coronary angiography enabled clinicians to assess the presence and extent of luminal narrowings in patients. 8 Determination of the clinical importance of coronary stenoses was possible at both ends of the spectrum, but it was eventually recognized that the haemodynamic importance of lesions of intermediate severity was not as readily defined. 9 ConFrom the Department of Medicine, Montreal Heart Institute, 5000 Belanger Street East, Montrtal, Qutbec, Canada H1T1C8. siderable interobserver variability in the interpretation of coronary angiograms represented another limitation? ~ Although the advent of quantitative coronary angiography has reduced the variability of the technique, it has not improved the ability to evaluate the physiological significance of intermediate lesions.Diagnostic methods to assess the physiological relevance of coronary narrowing were developed. Myocardial lactate production was measured during periods of increased oxygen demand, ~ but this technique requiring coronary sinus catheterization has fallen out of interest. Determination of coronary flow reserve, defined as the ratio between hyperaemic and baseline flow, then became possible. Early assessment of the absolute coronary flow reserve was performed after transient arterial occlusion and measurement of hyperemic flow with an electromagnetic flowmeter. 12 It was observed that normal coronary arteries could increase their flow fourfold during hyperaemia, whereas stenosed vessels lost that ability. However, this specific method obviously could not be used clinically.Positive-emission to...

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“…History of diabetes mellitus (%) History of smoking (%) H i w r y of myocardial infarction (%) Medications Nilrates (%a) C'.,l ciuiii-channel : (14) 82 (64) 40(31) 83 (65) 62 (48) 35 (27) 25 (20) 43 ( 34) 47 (37) 13 (10) 58 (45 Table 11.…”

Section: History Of Hypertension (70)mentioning

confidence: 99%

Effect of the stress level achieved during symptom‐limited exercise technetium‐99m sestamibi myocardial tomography on the detection of coronary artery disease

Stratmann

Younis

Wittry

et al. 1996

Clinical Cardiology

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Summary t)rrrk~mww':The stress level achieved during exercise thallium-20 1 myocardial imaging may influence its sensitivity for detecting coronary artery disease (CAD). The effect of exercise adequacy on the accuracy of technetium-99m sestamibi (MIBI) imaging has not been studied.tfypothesis: The study was undertaken to assess the effect of exercise level achieved on sensitivity for detecting CAD.Mcthods: A consecutive series of 250 patients (mean age 60 +-10 years) with CAD by angiography underwent symptom-limited exercise MIBI single-photon emission computed tomography. Single-vessel CAD was found in 66 patients, double-vessel CAD in 84, triple-vessel CAD in 80, and left m a n &.ease in 20.Krntlts: No significant differences were found in sensitivities of an abnormal MIBI scan or a reversible defect among 102 patients reaching 85% of age-predicted heart rate and 148 who did not (82 vs. 89% and 66 vs. 70%. respectively, p = NS). Patients (n = 128) able to exercise 5 6 min had a higher incidence of abnormal scans and reversible defects than 122 patients with a greater exercise duration (91 vs. 82% and 75 vs. 61 %, respectively, both p<0.05). Sensitivity of an abnormal MIBI scan for rnultivessel disease was greater than for single-vessel disease in patients who achieved 285% of age- predicted heart rate (91 vs. 59%, p6 min (89 vs. 66%, p6 min is associated with a significantly higher MIBI abnormality rate than a duration of >6 min, possibly reflecting the effect of myocardial ischemic burden on exercise ventricular function. Regardless of level of stress or its duration, exercise MIBI tomography improves the sensitivity for CAD detection compared with stress-induced ischemic ST depression.

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Correlation of pharmacological 99mTc-sestamibi myocardial perfusion imaging with poststenotic coronary flow reserve in patients with angiographically intermediate coronary artery stenoses.

Cited by 262 publications

References 41 publications

Contribution of Vasodilator Prostanoids and Nitric Oxide to Resting Flow, Metabolic Vasodilation, and Flow-Mediated Dilation in Human Coronary Circulation

Contribution of Vasodilator Prostanoids and Nitric Oxide to Resting Flow, Metabolic Vasodilation, and Flow-Mediated Dilation in Human Coronary Circulation

Predicting ischaemic events in the perioperative period: in search of the perfect tool

Effect of the stress level achieved during symptom‐limited exercise technetium‐99m sestamibi myocardial tomography on the detection of coronary artery disease

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