Diagnosis of coronary restenosis using coronary flow reserve measurements obtained through transthoracic Doppler echocardiography

Se Joong Rim, Young Guk Ko, Seok Min Kang, Jong Won Ha, Donghoon Choi, Yangsoo Jang, Namsik Chung

Research output: Contribution to journalArticle

Abstract

Background and Objectives: Coronary flow reserve (CFR) decreases in the presence of significant coronary ste nosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. Subjects and Methods: We studied 99 patients (71 males/28 females, mean age 58 ± 11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0 ± 1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 μg·kg-1·min-1). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. Results: CFRs in 69 patients without restenosis were 2.55 ± 0.99 at 48 hours after PCI and 2.93 ± 1.00 at follow-up (p < 0.005). CFRs in 30 patients with restenosis (> 50% in diameter stenosis) decreased significantly from 2.70 ± 1.01 at 48 hours after PCI to 1.98 ± 0.91 at follow-up (p < 0.001). There was a significant difference in CFR change (ratio of CFR followup/CFRinitial) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR = 0.76, AUC for CFR change = 0.82]. Conclusion: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.

Original languageEnglish
Pages (from-to)325-330
Number of pages6
JournalKorean Circulation Journal
Volume38
Issue number6
DOIs
Publication statusPublished - 2008 Jun 1

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Coronary Restenosis
Doppler Echocardiography
Percutaneous Coronary Intervention
Echocardiography
Area Under Curve
Arteries
Stable Angina
Unstable Angina
Left Ventricular Hypertrophy
Transducers
Intravenous Infusions
ROC Curve
Netherlands
Adenosine
Angiography
Pathologic Constriction
Myocardial Infarction

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{99914bdc3e844bcca48b72a63b829179,
title = "Diagnosis of coronary restenosis using coronary flow reserve measurements obtained through transthoracic Doppler echocardiography",
abstract = "Background and Objectives: Coronary flow reserve (CFR) decreases in the presence of significant coronary ste nosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. Subjects and Methods: We studied 99 patients (71 males/28 females, mean age 58 ± 11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0 ± 1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 μg·kg-1·min-1). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. Results: CFRs in 69 patients without restenosis were 2.55 ± 0.99 at 48 hours after PCI and 2.93 ± 1.00 at follow-up (p < 0.005). CFRs in 30 patients with restenosis (> 50{\%} in diameter stenosis) decreased significantly from 2.70 ± 1.01 at 48 hours after PCI to 1.98 ± 0.91 at follow-up (p < 0.001). There was a significant difference in CFR change (ratio of CFR followup/CFRinitial) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR = 0.76, AUC for CFR change = 0.82]. Conclusion: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.",
author = "Rim, {Se Joong} and Ko, {Young Guk} and Kang, {Seok Min} and Ha, {Jong Won} and Donghoon Choi and Yangsoo Jang and Namsik Chung",
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Diagnosis of coronary restenosis using coronary flow reserve measurements obtained through transthoracic Doppler echocardiography. / Rim, Se Joong; Ko, Young Guk; Kang, Seok Min; Ha, Jong Won; Choi, Donghoon; Jang, Yangsoo; Chung, Namsik.

In: Korean Circulation Journal, Vol. 38, No. 6, 01.06.2008, p. 325-330.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Diagnosis of coronary restenosis using coronary flow reserve measurements obtained through transthoracic Doppler echocardiography

AU - Rim, Se Joong

AU - Ko, Young Guk

AU - Kang, Seok Min

AU - Ha, Jong Won

AU - Choi, Donghoon

AU - Jang, Yangsoo

AU - Chung, Namsik

PY - 2008/6/1

Y1 - 2008/6/1

N2 - Background and Objectives: Coronary flow reserve (CFR) decreases in the presence of significant coronary ste nosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. Subjects and Methods: We studied 99 patients (71 males/28 females, mean age 58 ± 11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0 ± 1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 μg·kg-1·min-1). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. Results: CFRs in 69 patients without restenosis were 2.55 ± 0.99 at 48 hours after PCI and 2.93 ± 1.00 at follow-up (p < 0.005). CFRs in 30 patients with restenosis (> 50% in diameter stenosis) decreased significantly from 2.70 ± 1.01 at 48 hours after PCI to 1.98 ± 0.91 at follow-up (p < 0.001). There was a significant difference in CFR change (ratio of CFR followup/CFRinitial) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR = 0.76, AUC for CFR change = 0.82]. Conclusion: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.

AB - Background and Objectives: Coronary flow reserve (CFR) decreases in the presence of significant coronary ste nosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings. Subjects and Methods: We studied 99 patients (71 males/28 females, mean age 58 ± 11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0 ± 1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 μg·kg-1·min-1). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged. Results: CFRs in 69 patients without restenosis were 2.55 ± 0.99 at 48 hours after PCI and 2.93 ± 1.00 at follow-up (p < 0.005). CFRs in 30 patients with restenosis (> 50% in diameter stenosis) decreased significantly from 2.70 ± 1.01 at 48 hours after PCI to 1.98 ± 0.91 at follow-up (p < 0.001). There was a significant difference in CFR change (ratio of CFR followup/CFRinitial) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR = 0.76, AUC for CFR change = 0.82]. Conclusion: Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.

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