title: Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?
abstract: To study the relationship between the quantitatively assessed coronary artery dimensions and the regional coronary flow reserve as measured by digital subtraction cineangiography, we investigated 17 coronary arteries with a single discrete proximal stenosis and 12 normal coronary arteries before and after intracoronary administration of papaverine. Coronary flow reserve was found to be curvilinearly related to minimal luminal cross-sectional area (r = .92, SEE = 0.73) and to percentage area stenosis (r = .92, SEE = 0.74). Normal coronary arteries had a coronary flow reserve of 5.0 (+/- 0.8 [SD]), which differed significantly from the coronary flow reserve of the coronary arteries with obstructive disease, in which values ranging from 0.5 to 3.9 were found. Coronary arteries with a percentage area stenosis between 50% and 70% and a minimal luminal cross-sectional area between 2 and 4.5 mm2 differed significantly (p = .001), with respect to the coronary flow reserve, from coronary arteries with a percentage area stenosis in excess of 70% and a minimal luminal cross-sectional area less than 2 mm2. With the use of hemodynamic equations that describe the pressure loss over a stenosis, a theoretical pressure-flow relationship can be inferred that characterizes the severity of the stenosis. Based on this theoretical pressure-flow relationship, coronary arteries that have a limited coronary flow reserve and critical stenosis (distal coronary perfusion pressure below 40 mm Hg at coronary flow of 3 ml/sec) can be identified with high sensitivity (83%) and specificity (82%). Thus, in coronary artery disease the consequent reduction in coronary flow reserve can be predicted with reasonable accuracy by quantitative assessment of coronary artery dimensions.
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D001794:Blood Pressure / Q000187:drug effects; D002932:Cineangiography / Q000379:methods; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010208:Papaverine; D011379:Prognosis; D011857:Radiographic Image Interpretation, Computer-Assisted; D013382:Subtraction Technique
chemical_list: D010208:Papaverine