From the Division of Cardiology, Center of Internal Medicine, University
of Essen, Germany.
Correspondence to Dietrich Baumgart, MD, Division of Cardiology, Center of Internal Medicine, University of Essen, Hufelandstr 55, D-45122 Essen, Germany. E-mail dbaum3{at}t-online.de
Background—Myocardial fractional
flow reserve (FFR) is based on pressure measurements. We have now
sought to establish a Doppler-based concept of relative flow
velocity reserve (RFVR) for the functional assessment of
stenosis severity in epicardial coronary arteries. A
clear threshold value to discriminate the functional severity of a
coronary stenosis does not exist for coronary
flow velocity reserve (CVR) based on intracoronary Doppler
measurements. In contrast, the concept of FFR, which is based on
intracoronary pressure measurements, has been extensively
validated. An FFR value below 0.75 reliably indicates a
significant stenosis.
Methods and Results—RFVR is calculated as the ratio between
distal CVR in the stenosed target vessel and distal CVR in a
nonstenotic reference vessel. In 21 patients, RFVR was
determined in 24 target vessels by use of intracoronary
adenosine and correlated to the FFR, determined as the ratio of
mean poststenotic to aortic pressures, in the target vessel.
Stenosis severity was classified according to quantitative
coronary angiography analysis. Reference diameter was
3.0±0.4 mm (mean±SD), and area stenosis was 74±15%
(range, 40% to 95%). CVRs in the target and reference vessels were
2.1±0.5 and 2.6±0.7, respectively. FFR ranged from 0.49 to 0.99
(mean, 0.81±0.15) and RFVR from 0.53 to 1.0 (mean, 0.82±0.13).
Poststenotic CVR did not correlate with either percent area
stenosis (r=0.27, P=NS) or FFR
(r=0.33, P=NS). In contrast, FFR as well
as RFVR showed a curvilinear relation to percent area stenosis
(r=0.89, P<0.0001 and
r=0.79, P<0.0001, respectively). There
was a close linear correlation between FFR and RFVR
(r=0.91, P<0.0001).
Conclusions—RFVR correlates closely to FFR and to percent area
stenosis, whereas the correlation of CVR with FFR and percent
area stenosis is rather poor. RFVR is a promising new concept
for assessment of coronary stenosis severity and
clinical decision making based on Doppler measurements.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Improved Assessment of Coronary Stenosis Severity Using the Relative Flow Velocity Reserve
Key Words: catheterization • stenosis • blood flow velocity • angioplasty • diagnosis
This article has been cited by other articles:
 |
|
 |
|
  N. Sun, N. B. Wood, A. D. Hughes, S. A. M. Thom, and X. Yun Xu Effects of transmural pressure and wall shear stress on LDL accumulation in the arterial wall: a numerical study using a multilayered model Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H3148 - H3157. [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]
|
|
|
|
 |
|
 M. L. E. Vicario, L. Cirillo, G. Storto, T. Pellegrino, N. Ragone, L. Fontanella, M. Petretta, D. Bonaduce, and A. Cuocolo Influence of Risk Factors on Coronary Flow Reserve in Patients with 1-Vessel Coronary Artery Disease J. Nucl. Med., September 1, 2005; 46(9): 1438 - 1443. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Roy, R. K. Banerjee, L. H. Back, M. R. Back, S. Khoury, and R. W. Millard Delineating the guide-wire flow obstruction effect in assessment of fractional flow reserve and coronary flow reserve measurements Am J Physiol Heart Circ Physiol, July 1, 2005; 289(1): H392 - H397. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Wieneke, C. von Birgelen, M. Haude, H. Eggebrecht, S. Mohlenkamp, A. Schmermund, D. Bose, C. Altmann, T. Bartel, and R. Erbel Determinants of coronary blood flow in humans: quantification by intracoronary Doppler and ultrasound J Appl Physiol, March 1, 2005; 98(3): 1076 - 1082. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. Voudris, D. Avramides, M. Koutelou, J. Malakos, A. Manginas, M. Papadakis, and D. V. Cokkinos Relative Coronary Flow Velocity Reserve Improves Correlation With Stress Myocardial Perfusion Imaging in Assessment of Coronary Artery Stenoses Chest, October 1, 2003; 124(4): 1266 - 1274. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Stoel, F. Zijlstra, and C. A. Visser Frame Count Reserve Circulation, June 24, 2003; 107(24): 3034 - 3039. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Albertal, E. Regar, G. Van Langenhove, S.G. Carlier, P. Serrano, E. Boersma, B. Bruyne, C. Di Mario, J. Piek, and P.W. Serruys Flow velocity and predictors of a suboptimal coronary flow velocity reserve after coronary balloon angioplasty Eur. Heart J., January 2, 2002; 23(2): 133 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. S. Werner, M. Ferrari, B. M. Richartz, O. Gastmann, and H. R. Figulla Microvascular Dysfunction in Chronic Total Coronary Occlusions Circulation, September 4, 2001; 104(10): 1129 - 1134. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Albertal, G Van Langenhove, E Regar, I P Kay, D Foley, G Sianos, K Kozuma, T Beijsterveldt, S G Carlier, J A Belardi, et al. Uncomplicated moderate coronary artery dissections after balloon angioplasty: good outcome without stenting Heart, August 1, 2001; 86(2): 193 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Kern and B. Meier Evaluation of the Culprit Plaque and the Physiological Significance of Coronary Atherosclerotic Narrowings Circulation, June 26, 2001; 103(25): 3142 - 3149. [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
|
|
|
|
|
|
J. Herrmann, M. Haude, A. Lerman, R. Schulz, L. Volbracht, J. Ge, A. Schmermund, H. Wieneke, C. von Birgelen, H. Eggebrecht, et al. Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation Circulation, May 15, 2001; 103(19): 2339 - 2345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. A. J. Chamuleau, M. Meuwissen, B. L. F. van Eck-Smit, K. T. Koch, A. de Jong, R. J. de Winter, C. E. Schotborgh, M. Bax, H. J. Verberne, J. G. P. Tijssen, et al. Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestambi single-photon emission computed tomography in patients with two-vessel coronary artery disease J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1316 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haude, D. Baumgart, E. Verna, J. J. Piek, C. Vrints, P. Probst, and R. Erbel Intracoronary Doppler- and Quantitative Coronary Angiography-Derived Predictors of Major Adverse Cardiac Events After Stent Implantation Circulation, March 6, 2001; 103(9): 1212 - 1217. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Meuwissen, S. A. J. Chamuleau, M. Siebes, C. E. Schotborgh, K. T. Koch, R. J. de Winter, M. Bax, A. de Jong, J. A. E. Spaan, and J. J. Piek Role of Variability in Microvascular Resistance on Fractional Flow Reserve and Coronary Blood Flow Velocity Reserve in Intermediate Coronary Lesions Circulation, January 16, 2001; 103(2): 184 - 187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Di Mario, J. W. Moses, T. J. Anderson, R. Bonan, T. Muramatsu, A. C. Jain, J. Suarez de Lezo, S. Y. Cho, M. Kern, I. T. Meredith, et al. Randomized Comparison of Elective Stent Implantation and Coronary Balloon Angioplasty Guided by Online Quantitative Angiography and Intracoronary Doppler Circulation, December 12, 2000; 102(24): 2938 - 2944. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Wieneke, M. Haude, J. Ge, C. Altmann, S. Kaiser, D. Baumgart, C. von Birgelen, D. Welge, and R. Erbel Corrected coronary flow velocity reserve: a new concept for assessing coronary perfusion J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1713 - 1720. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Herrmann, G. Chang, B. D. Klugherz, and P. D. Mahoney Hemodynamic Effects of Sildenafil in Men with Severe Coronary Artery Disease N. Engl. J. Med., June 1, 2000; 342(22): 1622 - 1626. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Kern Coronary Physiology Revisited : Practical Insights From the Cardiac Catheterization Laboratory Circulation, March 21, 2000; 101(11): 1344 - 1351. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.J Piek, E Boersma, C di Mario, E Schroeder, C Vrints, P Probst, B de Bruyne, C Hanet, E Fleck, M Haude, et al. Angiographical and Doppler flow-derived parameters for assessment of coronary lesion severity and its relation to the result of exercise electrocardiography Eur. Heart J., March 2, 2000; 21(6): 466 - 474. [Abstract] [PDF]
|
|
|
|
|
|
M. J. Kern, S. Puri, R. G. Bach, T. J. Donohue, P. Dupouy, E. A. Caracciolo, W. R. Craig, F. Aguirre, E. Aptecar, T. L. Wolford, et al. Abnormal Coronary Flow Velocity Reserve After Coronary Artery Stenting in Patients : Role of Relative Coronary Reserve to Assess Potential Mechanisms Circulation, December 21, 1999; 100(25): 2491 - 2498. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Colombo and C. Briguori Optimal balloon angioplasty versus elective stent implantation J. Am. Coll. Cardiol., December 1, 1999; 34(7): 1907 - 1909. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Gruberg, G. S. Mintz, L. F. Satler, K. M. Kent, A. D. Pichard, and M. B. Leon Intravascular imaging and physiologic lesion assessment to define critical coronary stenoses Ann. Thorac. Surg., October 1, 1999; 68(4): 1547 - 1551. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H J Verberne, J J Piek, R A M van Liebergen, K T Koch, J M Schroeder-Tanka, and E A van Royen Functional assessment of coronary artery stenosis by Doppler derived absolute and relative coronary blood flow velocity reserve in comparison with 99mTc MIBI SPECT Heart, October 1, 1999; 82(4): 509 - 514. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. B. Sorensen, P.-O. Freskgard, L. S. Nielsen, L. V. M. Rao, M. Ezban, and L. C. Petersen Factor VIIa-induced p44/42 Mitogen-activated Protein Kinase Activation Requires the Proteolytic Activity of Factor VIIa and Is Independent of the Tissue Factor Cytoplasmic Domain J. Biol. Chem., July 23, 1999; 274(30): 21349 - 21354. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Ferrari, B.a. Schnell, G. S. Werner, and H. R. Figulla Safety of deferring angioplasty in patients with normal coronary flow velocity reserve J. Am. Coll. Cardiol., January 1, 1999; 33(1): 82 - 87. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Albertal, M. Voskuil, J.J. Piek, B. de Bruyne, G. Van Langenhove, P.I. Kay, M.A. Costa, E. Boersma, T. Beijsterveldt, J.E. Sousa, et al. Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome Circulation, April 2, 2002; 105(13): 1573 - 1578. [Abstract] [Full Text] [PDF]
|
|