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CLINICAL STUDIES

Corrected coronary flow velocity reserve: a new concept for assessing coronary perfusion

Heinrich Wieneke, MD^*, Michael Haude, MD^*, Junbo Ge, MD, FACC, Christoph Altmann, MD^*, Sigrid Kaiser, MS, Dietrich Baumgart, MD^*, Clemens von Birgelen, MD, PhD^*, Dirk Welge, MD^* and Raimund Erbel, MD, FACC^*

^* Department of Cardiology, University Hospital Essen, Center of Internal Medicine, Essen, Germany
Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Shanghai, China
Institute for Medical Informatics, Biometry and Epidemiology, University Clinics of Essen, Essen, Germany

Manuscript received July 29, 1999; revised manuscript received December 10, 1999, accepted February 9, 2000.

Reprint requests and correspondence: Dr. Heinrich Wieneke, Department of Cardiology, University Hospital Essen, D-45122 Essen, Germany
heinrich.wieneke{at}uni-essen.de

OBJECTIVES

In order to limit the variability of coronary flow velocity reserve (CFVR), we analyzed which factors independently affect CFVR and established a new parameter integrating these factors.

BACKGROUND

Coronary flow velocity reserve (CFVR) is a frequently used parameter for evaluating the physiological significance of epicardial stenosis and microvascular function. Since CFVR measurements are done in substantially different hemodynamic and clinical situations, interpretation of CFVR requires correction for major influencing factors.

METHODS

In 141 patients with angina-like symptoms and angiographically unobstructed coronary arteries, intracoronary Doppler measurements were performed in at least two coronary vessels. Coronary flow velocity reserve was calculated as the ratio of hyperemic average peak velocity (hAPV), after intracoronary bolus of adenosine, to baseline average peak velocity (bAPV).

RESULTS

Analysis of covariance revealed that only bAPV (p < 0.0001) and age (p < 0.0001) were independent factors influencing CFVR. Based on a regression model for estimation of predicted CFVR values, individual CFVR values (CFVR_ind) obtained at different bAPV and age were transformed in corrected CFVR values (CFVR_corr) by relating them to a mean bAPV of 15 cm/s and a mean age of 55 years. The transformation from CFVR_ind into CFVR_corr for the left anterior descending artery can be done by using the following equation: CFVR_corr = 2.85*CFVR_ind*10 ^{0.48*log(bAPV) + 0.0025*age – 1.16}. When applying this new parameter to conditions assumed to cause microvascular dysfunction, analysis showed that only patients with diabetes showed a significant decrease of traditional CFVR and CFVR_corr, whereas a history of hypertension and current smoking habit had no influence on CFVR_corr.

CONCLUSIONS

The concept of CFVR_corr standardizes CFVR for bAPV and age as the major physiological determinants. Especially in patients with microvascular dysfunction, this approach may help to discriminate between conditions directly affecting vasodilator reserve and conditions primarily affecting bAPV.

Abbreviations and Acronyms   a = log10 transformed for statistical analysis   bAPV = baseline average peak velocity   BMI = body mass index   CFVR = coronary flow velocity reserve   CFVRcorr = corrected coronary flow velocity reserve—CFVR value corrected for bAPV and age   CFVRind = individual coronary flow velocity reserve of a certain patient   CFVRpred = predicted coronary flow velocity reserve—CFVR value predicted by the covariance model for a certain bAPV and age   ECG = electrocardiogram   hAPV = hyperemic average peak velocity   LAD = left anterior descending artery   LCX = left circumflex artery   RCA = right coronary artery

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