Abstract 370: Are the Results of Intracoronary Pressure Wire and Dobutamine Stress Echo Interchangeable in the Assessment of Moderate Coronary Artery Stenoses?
Background: Patients with angiographically moderate (50 –75%) coronary artery stenoses can pose a considerable diagnostic dilemma. Additional functional testing by dobutamine stress echocardiography (DSE) or pressure wire (PW) have both been proven to be invaluable in guiding interventional management. However, they are measuring different parameters. We assessed the agreement between these two tests on functional significance of such stenoses.
Methods: We performed a retrospective analysis of all patients with at least one moderate stenosis who had undergone both, DSE and PW within 6 months of each other with no change in clinical status. A fractional flow reserve (FFR)<0.8 was regarded as positive as was >=2 abnormal segments during DSE.
Results: 65 patients (22 female, 43 male, mean age 63, min. 44, max 80, standard deviation 9.6) were analysed. In total 84 lesions were assessed by both PW and DSE. 54 were in the left anterior descending (LAD), 14 in the left circumflex (LCx), and 16 in the right coronary artery (RCA). Results were in agreement in 40 lesions (48%). Poor agreement was noted in RCA (4/16 lesions, 25%), whereas DSE and PW results were more consistent in LAD (28/54 lesions, 52%) and LCx (8/14 lesions, 57%).
Conclusion: Although DSE and PW are both used to assess the functional severity of moderate stenoses, it is important to remember that the tests are measuring different things: FFR represents flow limitation of a discrete stenosis whereas DSE demonstrates reversible ischaemia in the whole territory of a coronary artery. These data suggest that the two investigations should hypothetically play different roles in the assessment of the significance of known coronary lesions.