Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve

Baumgart, Dietrich; Haude, Michael; Goerge, Guenter; Ge, Junbo; Vetter, Sabine; Dagres, Nikolaos; Heusch, Gerd; Erbel, Raimund

doi:10.1161/01.cir.98.1.40

Cited by 108 publications

(79 citation statements)

References 30 publications

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“…4,5 A good long-term outcome has recently been reported after stent implantation in patients with a relative CFVR Ͼ0.88 and minimal luminal diameter Ͼ2.77 mm. 15 Moreover, relative CFVR may identify patients with global microcirculatory disease.…”

Section: Impaired Cfvr After Angioplasty In Relation To Clinical Outcomementioning

confidence: 98%

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Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

et al. 2002

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Background-Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. Methods and Results-As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (Ն2.5 or Ͻ2.5) at the end of the procedure. A CFVR Ͻ2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR

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Section: Impaired Cfvr After Angioplasty In Relation To Clinical Outcomementioning

confidence: 98%

“…Relative CFVR was calculated as the ratio of the absolute CFVR in the target vessel to the absolute CFVR in the reference artery. 4 The CFVR was considered normalized when the relative CFVR was Ն0.8. 5,6 End Points…”

Section: Cfvr Measurementmentioning

confidence: 99%

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

et al. 2002

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“…13,14 Intravenous heparin medication was started before intervention (10 000 IU bolus and 1000 IU/h infusion). After coronary stenting was performed, ticlopidine (500 mg/d) or clopidogrel (75 mg/d) was given for 4 weeks in addition to lifelong aspirin medication (100 mg/d).…”

Section: Interventional Proceduresmentioning

confidence: 99%

“…Relative coronary flow velocity reserve (rCVR) was defined as the ratio of CVR in the target vessel to CVR in the reference vessel. 14 …”

Section: Intracoronary Doppler Analysismentioning

confidence: 99%

Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation

Herrmann¹,

Haude

Lerman³

et al. 2001

Circulation

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Background-Residual reduction of relative coronary flow velocity reserve (rCVR) after successful coronary intervention has been related to microvascular impairment. However, the incidence of cardiac enzyme elevation as a surrogate marker of an underlying embolic myocardial injury in these cases has not been studied. Methods and Results-A series of 55 consecutive patients with successful coronary stenting, periprocedural intracoronary Doppler analysis, and determination of creatine kinase (CK; upper limit of normal [ULN] for women 70 IU/L, for men 80 IU/L) and cardiac troponin T (cTnT; bedside test, threshold 0.1 ng/mL) before and 6, 12, and 24 hours after intervention were studied. Postprocedural rCVR was the only intracoronary Doppler parameter that independently correlated with cTnT (rϭϪ0.498, PϽ0.001) and CK outcome (rϭϪ0.406, Pϭ0.002). Receiver operating characteristic analysis identified a postprocedural rCVR of 0.78 as the best discriminating value, with a sensitivity of 83.3% and 69.2% and a specificity of 79.1% and 76.2% for detection of cTnT and CK elevation, respectively. Stratified according to this cutoff value, the incidence of cTnT elevation was 52.6% in patients with (nϭ19) and 5.6% in patients without (nϭ36) a postprocedural rCVR Ͻ0.78 (PϽ0.001), associated with a CK elevation Ͼ1 times the ULN in 36.8% and 5.6% (Pϭ0.005) of patients, respectively. Conclusions-Cardiac marker elevation can frequently be found after coronary procedures that are associated with a persistent reduction of rCVR, indicating procedural embolization of atherothrombotic debris with microvascular impairment and myocardial injury as a potential underlying mechanism.

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“…11 In addition, relative CVR (CVR rel ) was calculated as the ratio of absolute CVR distal to the target lesion divided by absolute CVR in the unobstructed reference artery. [12][13][14] Blood flow velocity recordings and coronary angiograms were analyzed offline in a core laboratory at the University of Essen.…”

Section: Coronary Blood Flow Velocity Measurementsmentioning

confidence: 99%

Intracoronary Doppler– and Quantitative Coronary Angiography–Derived Predictors of Major Adverse Cardiac Events After Stent Implantation

et al. 2001

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Background-Distal coronary flow velocity reserve (CVR) is significantly improved after a successful balloon angioplasty (PTCA). Furthermore, a postinterventional CVR Ͼ2.5 and a percent diameter stenosis (%DS) Յ35% are predictive for a low incidence of major adverse cardiac events (MACE) at 6 months of 16%. Similar results are lacking for coronary stenting. Methods and Results-In 150 patients, baseline and hyperemic coronary flow velocities were recorded with a Doppler guidewire distal to the target lesion and in an unobstructed reference artery before and after PTCA, after stenting, and at 6 months. Distal CVR and relative CVR (CVR rel ) were calculated. Logistic regression and receiver operating characteristic analyses were applied to determine prognostic cutoff values of CVR, CVR rel , %DS, and minimal lumen diameter separately and in combination to predict MACE at 6 months. After stenting, CVR (2.96Ϯ0.87 versus 2.40Ϯ0.7; Pϭ0.001), CVR rel (1.02Ϯ0.24 versus 0.81Ϯ0.24; Pϭ0.001), and minimal lumen diameter (2.98Ϯ0.56 versus 2.11Ϯ0.74 mm; Pϭ0.001) were significantly higher than after PTCA. Thirty-three patients developed MACE. A postinterventional CVR rel Ͼ0.88 was the best single predictor of MACE, with an incidence of 6.8%, whereas the combination of a CVR rel Ͼ0.88 and a %DS Յ11.2% predicted an incidence of MACE of 1.5%. Conclusions-Measurement of CVR rel and %DS after stent implantation are best suitable to predict MACE at 6 months.

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Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve

Cited by 108 publications

References 30 publications

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation

Intracoronary Doppler– and Quantitative Coronary Angiography–Derived Predictors of Major Adverse Cardiac Events After Stent Implantation

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