|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2002; 39:852-858 © 2002 by the American College of Cardiology Foundation |
* Departments of Cardiology, Academic Medical Center-University of Amsterdam, The Netherlands
University Hospital Groningen, The Netherlands
Free University Medical Center Amsterdam, The Netherlands
University Hospital Maastricht, The Netherlands
|| Catharina Hospital Eindhoven, The Netherlands
¶ OLVG Hospital Amsterdam, The Netherlands
# Department of Nuclear Medicine, Academic Medical Center-University of Amsterdam, The Netherlands
** Department of Clinical Epidemiology and Biostatistics, Academic Medical Center-University of Amsterdam, The Netherlands
Manuscript received June 28, 2001; revised manuscript received October 4, 2001, accepted December 12, 2001.
* Reprint requests and correspondence: Dr. Jan J. Piek, Academic Medical Center, University of Amsterdam, Department of Cardiology, Room B2-108, Meibergdreef 9, P O Box 22660, 1100 DD, Amsterdam, The Netherlands.
s.a.chamuleau{at}amc.uva.nl
OBJECTIVES: This study aimed to investigate the roles of intracoronary derived coronary flow velocity reserve (CFVR) and myocardial perfusion scintigraphy (single photon emission computed tomography, or SPECT) for management of an intermediate lesion in patients with multivessel coronary artery disease.
BACKGROUND: Evaluation of the functional significance of intermediate coronary narrowings (40% to 70% diameter stenosis) is important for clinical decision making and risk stratification.
METHODS: In a prospective, multicenter study, SPECT was performed in 191 patients with stable angina and multivessel disease and scheduled for angioplasty (percutaneous transluminal coronary angioplasty, or PTCA) of a severe coronary narrowing. Coronary flow velocity reserve was determined selectively distal to an intermediate lesion in another artery using a Doppler guidewire. Percutaneous transluminal coronary angioplasty of the intermediate lesion was deferred when SPECT was negative or CFVR 
2.0. Patients were followed for one year to document major cardiac events (death, infarction, revascularization), related to the intermediate lesion.
RESULTS: Reversible perfusion defects were documented in the area of the intermediate lesion in 30 (16%) patients; CFVR was positive in 46 (24%) patients. Percutaneous transluminal coronary angioplasty of the intermediate lesion was deferred in 182 patients. During follow-up, 19 events occurred (3 myocardial infarctions, 16 revascularizations). Coronary flow velocity reserve was a more accurate predictor of cardiac events than was SPECT; relative risk: CFVR 3.9 (1.7 to 9.1), p < 0.05; SPECT 0.5 (0.1 to 3.2), p = NS. Multivariate analysis revealed CFVR as the only significant predictor for cardiac events.
CONCLUSIONS: Deferral of PTCA of intermediate lesions in multivessel disease is safe when CFVR 2.0 (event rate 6%). This selective evaluation of coronary lesion severity during cardiac catheterization allows a more accurate risk stratification than does SPECT, which is important for clinical decision making in this patient cohort.
| |||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  S. M. Bierig, P. Mikolajczak, S. C. Herrmann, N. Elmore, M. Kern, and A. J. Labovitz Comparison of myocardial contrast echocardiography derived myocardial perfusion reserve with invasive determination of coronary flow reserve Eur J Echocardiogr, August 22, 2008; (2008) jen217v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Meimoun, T. Benali, F. Elmkies, S. Sayah, A. Luycx-Bore, L. Doutrelan, Z. Hamdane, J. Boulanger, and C. Tribouilloy Prognostic value of transthoracic coronary flow reserve in medically treated patients with proximal left anterior descending artery stenosis of intermediate severity Eur J Echocardiogr, June 25, 2008; (2008) jen190v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Pries, H. Habazettl, G. Ambrosio, P. R. Hansen, J. C. Kaski, V. Schachinger, H. Tillmanns, G. Vassalli, I. Tritto, M. Weis, et al. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings Cardiovasc Res, June 25, 2008; (2008) cvn136v2. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Kern, A. Lerman, J.-W. Bech, B. De Bruyne, E. Eeckhout, W. F. Fearon, S. T. Higano, M. J. Lim, M. Meuwissen, J. J. Piek, et al. Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization Laboratory: A Scientific Statement From the American Heart Association Committee on Diagnostic and Interventional Cardiac Catheterization, Council on Clinical Cardiology Circulation, September 19, 2006; 114(12): 1321 - 1341. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. P. Salm, J. J. Bax, H. W. Vliegen, S. E. Langerak, P. Dibbets, J. W. Jukema, H. J. Lamb, E. K.J. Pauwels, A. de Roos, and E. E. van der Wall Functional significance of stenoses in coronary artery bypass grafts: Evaluation by single-photon emission computed tomography perfusion imaging, cardiovascular magnetic resonance, and angiography J. Am. Coll. Cardiol., November 2, 2004; 44(9): 1877 - 1882. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Boon, J. van Goudoever, J. J. Piek, and G. A. van Montfrans ST Segment Depression Criteria and the Prevalence of Silent Cardiac Ischemia in Hypertensives Hypertension, March 1, 2003; 41(3): 476 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Piek, S. A. J. Chaumuleau, B. L. F. van Eck-Smit, and J. G. P. Tijssen All allusions to the great war aside ... J. Am. Coll. Cardiol., August 7, 2002; 40(3): 573 - 573. [Full Text] [PDF]
|
|
|
|
|
|
D. D. Miller Coronary flow studies for risk stratification in multivessel disease: A physiologic bridge too far? J. Am. Coll. Cardiol., March 6, 2002; 39(5): 859 - 863. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
