(Circulation. 1997;96:484-490.)
© 1997 American Heart Association, Inc.
Articles |
Intracoronary Doppler Assessment of Moderate Coronary Artery Disease
Comparison With 201Tl Imaging and Coronary Angiography
From Winthrop-University Hospital (L.I.H., R.M.S.), Mineola, NY; St Joseph's Hospital (C.C.), Atlanta, Ga; Washington Hospital Center (J.P.), Washington, DC; West Haven (Conn) Veterans Administration Hospital (L.I.D.); Allegheny General Hospital (J.D.J.), Pittsburgh, Pa; University of Massachusetts, Worcester (S.T.D., B.J.V., S.B., Y.M., J.A.L.); St Luke's Hospital (A.A.), Milwaukee, Wis; Galicia Medical Group (R.K.), Wichita, Kan; Methodist Hospital (W.C.G.), Houston, Tex; and Yale University (M.C.), New Haven, Conn.
Correspondence to Louis I. Heller, Division of Cardiology, Winthrop-University Hospital, 222 Station Plaza N, Suite 408, Mineola, NY 11501.
Background Coronary angiography may not reliably predict whether a stenosis causes exercise-induced ischemia. Intracoronary Doppler ultrasound may enhance diagnostic accuracy by providing a physiological assessment of stenosis severity. The goal of this study was to compare intracoronary Doppler ultrasound with both 201Tl imaging and coronary angiography.
Methods and Results Fifty-five patients with 67
stenotic coronary arteries underwent coronary
angiography with intracoronary Doppler ultrasound and had
exercise 201Tl testing within a 1-week period.
Coronary flow reserve was measured, and analyses were
performed by independent core laboratories. The mean stenosis
was 59±12%; 51 of 67 stenoses were intermediate in severity
(40% to 70%). A coronary flow reserve <1.7 predicted the
presence of a stress 201Tl defect in 56 of 67
stenoses (agreement=84%; 
=0.67; 95% CI=0.48 to 0.86). In
the patients who achieved 75% of their predicted maximum heart rate,
the Doppler and 201Tl imaging data agreed in 46 of 52
stenoses (agreement=88%; =0.77; 95%CI=0.57 to 0.97).
Scatter was evident when angiography was compared with coronary
flow reserve (r=.43), and the angiogram did not reliably
predict the results of the 201Tl stress test (=0.21;
agreement=57% to 63%).
Conclusions Doppler-derived coronary flow reserve accurately predicts the presence of exercise-induced ischemia on stress 201Tl imaging, and coronary angiography does not reliably assess the physiological significance of an intermediate coronary stenosis.
Key Words: ultrasonics • angiography • stenosis • regional blood flow • imaging
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