Periprocedural Doppler coronary blood flow predictors of myocardial perfusion abnormalities and cardiac events after successful coronary interventions.
Thirty-four consecutive patients had coronary flow velocity assessed under basal and hyperemic conditions in the proximal and distal coronary artery, followed by rest-stress technetium 99m sestamibi myocardial tomography within 3 months of successful coronary angioplasty. In spite of significant angiographic improvement, 29% of patients had a persistent reversible myocardial perfusion defect associated with a residual abnormality of the proximal-to-distal coronary average peak velocity ratio (p/d APV = 2.2 +/- 1.5 vs 1.1 +/- 0.6; p = 0.02). Patients with an abnormal p/d APV ratio (>1.7) had more numerous angioplasty-zone perfusion defects (4.2 +/- 3.3 vs 0.8 +/- 2.0; p = 0.005). Multivariable analysis of clinical, angiographic, coronary flow, and scintigraphic data demonstrated that the relative risk of cardiac events (n = 11) was greatest in patients with a reversible angioplasty-zone perfusion defect (relative risk, 5.5), poststenotic coronary flow reserve <2.0 (relative risk, 8.3) and p/d APV ratio >1.7 (relative risk, 6.2). Residual basal coronary flow-velocity abnormalities are significant physiologic correlates of stress-induced myocardial perfusion defects and are a prognostic covariable associated with future ischemic cardiac events.
Miller
D D
DD
Department of Internal Medicine, Division of Cardiology, Saint Louis University Health Sciences Center, Missouri 63110-0250, USA.
Esparza-Negrete
J
J
Donohue
T J
TJ
Mechem
C
C
Shaw
L J
LJ
Byers
S
S
Kern
M J
MJ
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011877:Radionuclide Imaging; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi