Safety of deferring angioplasty in patients with normal coronary flow velocity reserve

Ferrari, Markus; Schnell, Bärbel; Werner, Gerald S.; Figulla, Hans R.

doi:10.1016/s0735-1097(98)00552-x

Cited by 82 publications

(32 citation statements)

References 27 publications

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“…Moreover, risk factor modifications have had positive effect on echocardiography-derived CFVR in hypertension (17,26). Also, in a previous study where patients were divided into percutaneous transluminal coronary angioplasty (PTCA) group (CFVR Ͻ 2.0) and the non-PTCA group (CFVR Ն 2.0), the non-PTCA group had fewer major adverse cardiac events and angina symptoms than the PTCA group during the 15-mo follow-up period (12). However, the prognostic value of CFR has not been reported in longitudinal studies.…”

Section: Discussionmentioning

confidence: 97%

Determinants of coronary flow velocity reserve in healthy young men

Kiviniemi

Snapir²,

Saraste³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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. Determinants of coronary flow velocity reserve in healthy young men. Am J Physiol Heart Circ Physiol 291: H564 -H569, 2006. First published February 24, 2006 doi:10.1152/ajpheart.00915.2005.-The objective of this study was to identify risk markers for attenuated coronary flow velocity reserve (CFVR) that exist in healthy young men without evident atherosclerotic risk factors. Coronary blood flow velocity was measured with transthoracic Doppler echocardiography at baseline and during adenosine infusion in 37 healthy nonsmoking men [mean age, 27 yr (SD 4.0)]. Body composition and distribution of fat tissue were assessed with anthropometric measures and regulation of fat metabolism by determination of adiponectin and leptin levels. Physical performance capacity was tested with ergospirometry. The mean body mass index was 23 kg/m 2 (SD 1.9), waist-to-hip ratio was 0.84 (SD 0.04), and CFVR was 3.5 (SD 0.61). Obesity indexes at study outset, leptin, adiponectin, maximal load (Max load in W/kg) and maximal oxygen consumption (V O2 peak in ml ⅐ kg Ϫ1 ⅐ min Ϫ1 ) in ergospirometry, ratepressure product, and heart rate at rest were significantly associated with CFVR. In multivariate analysis, Max load (in W/kg) and waistto-hip ratio were the only independent predictors of CFVR. We found no relationship between CFVR and serum lipids or body mass index. We conclude that abdominal fat accumulation and low aerobic fitness are independently associated with CFVR in men.transthoracic Doppler echocardiography; physical capacity in ergospirometry; visceral adipose tissue

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Section: Discussionmentioning

confidence: 97%

Determinants of coronary flow velocity reserve in healthy young men

Kiviniemi

Snapir²,

Saraste³

et al. 2006

American Journal of Physiology-Heart and Circulatory Physiology

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“…It appears reasonably safe to defer percutaneous coronary intervention in patients with intermediate coronary lesions (50% to 69%) if the CFR is Ն2. 22 Moreover, patients with intermediate coronary stenoses who present with a good fractional flow reserve (Ն0.75) have a low risk of cardiac death or myocardial infarction (Ͻ1% annually), a risk that is not decreased by stenting the related lesion. 23 Simultaneous morphologic and functional (metabolic and/or perfusion) information obtained from hybrid positron emission computed tomography and single photon emission computed tomography-computed tomography scans in a single test has been suggested.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Coronary Flow Reserve Measured by Echocardiography to Improve the Identification of Significant Left Anterior Descending Coronary Artery Stenosis Assessed by Multidetector Computed Tomography

Pizzuto

Voci

Bartolomucci

et al. 2009

The American Journal of Cardiology

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Multidetector computed tomography (MDCT) detects coronary artery disease. However, an overestimation of coronary artery stenosis and artifacts can prevent accurate identification of significant coronary narrowing. The combination of MDCT with coronary flow reserve (CFR), the hyperemic/baseline peak flow velocity ratio, measured by transthoracic Doppler echocardiography might be helpful. We studied 144 consecutive patients with CFR and quantitative coronary angiography, obtained using both MDCT and invasive coronary angiography (reference method). It was hypothesized that the CFR might provide an incremental value to MDCT in detecting significant (>70%) left anterior descending (LAD) coronary artery stenosis. A CFR cutoff of <2 was used to discriminate significant stenosis. CFR was feasible in 141 (98%) of 144 patients, and MDCT was feasible in 131 (91%) of 144 patients (p <0.02). In a univariate model, the prediction of significant LAD stenosis was slightly, but significantly (p <0.0001), better with CFR (sensitivity 90%, specificity 96%, positive predictive value 84%, negative predictive value 97%, and diagnostic accuracy 94%, chi-square 97.5) than with MDCT (sensitivity 80%, specificity 93%, positive predictive value 71%, negative predictive value 95%, diagnostic accuracy 90%, chi-square 63.2). When the findings from transthoracic Doppler echocardiography and MDCT agreed, the diagnostic accuracy increased (96%; chi-square 86.1, p <0.0001). In a multivariate prediction of significant LAD stenosis using a logistic neural network, CFR overshadowed MDCT, and the area under the receiver operating curve was 0.99. Of the 13 patients missed by MDCT, the diagnostic accuracy of transthoracic Doppler echocardiog-raphy to predict significant LAD stenosis was 100%. Thus, CFR could improve the diagnostic accuracy of MDCT to detect significant LAD stenosis. © 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104:657-664) Noninvasive coronary angiography by multidetector computed tomography (MDCT) has been increasingly used as a diagnostic tool to study the coronary anatomy in patients with suspected coronary artery disease and/or multiple risk factors. 1-6 Agreement in published studies is substantial that negative findings on MDCT virtually exclude coronary atherosclerosis; however, quantitation of coronary artery stenosis is difficult. 1-6 Therefore, a noninvasive mul-timodality imaging approach integrating morphologic and functional information has been suggested. 7 Transthoracic color Doppler echocardiography (TDE) allows the measurement of the coronary flow reserve (CFR) in the left anterior descending (LAD) coronary artery, 8 a useful parameter to detect significant (70%) narrowing in the native coronary artery, 8 as well as in the stented and/or grafted LAD artery. 9-12 The CFR might provide incremental functional information on the collateral circulation when chronic total coronary occlusion is present. 13 We compared the value of LAD CFR versus MDCT to predict significant (70%) LAD stenosis, using invasive ...

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“…17,18 A CFVRϽ2.0 was observed in only 12% of normal subjects, indicating dysregulation of the peripheral resistive arterioles (ie, microvascular dysfunction). 19 To discriminate between epicardial and myocardial flow impairment, relative CFVR can be calculated; however, this measurement requires a normal reference vessel without stenosis.…”

Section: Detection Of Microvascular Dysfunctionmentioning

confidence: 99%

Microvascular Dysfunction in Chronic Total Coronary Occlusions

et al. 2001

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Background-Microvascular dysfunction is defined as reduced coronary flow reserve in the absence of an epicardial stenosis. This study determined its prevalence and relation to regional myocardial function in chronic total coronary occlusions (TCO). Methods and Results-After recanalization and stenting of a TCO (duration, Ͼ4 weeks) in 42 patients, coronary flow velocity reserve (CFVR) was measured by intracoronary Doppler. In a subset of 27 patients, intracoronary pressure was recorded to obtain the fractional flow reserve (FFR). In 21 patients, the CFVR was reassessed after 24 hours. CFVR was Ͻ2.0 in 55% of all patients. In the subgroup with simultaneous pressure recordings, 52% of patients showed a CFVRϽ2.0 and a FFRՆ0.

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Safety of deferring angioplasty in patients with normal coronary flow velocity reserve

Cited by 82 publications

References 27 publications

Determinants of coronary flow velocity reserve in healthy young men

Determinants of coronary flow velocity reserve in healthy young men

Usefulness of Coronary Flow Reserve Measured by Echocardiography to Improve the Identification of Significant Left Anterior Descending Coronary Artery Stenosis Assessed by Multidetector Computed Tomography

Microvascular Dysfunction in Chronic Total Coronary Occlusions

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