Correlations between coronary flow reserve measured with a Doppler guide wire and treadmill exercise testing.
We compared exercise test results to a physiologic depiction of stenosis severity, coronary flow reserve (CFR), measured with a Doppler guide wire in 35 patients with single-vessel coronary disease. Group 1 (n = 21) had abnormal CFR, and group 2 (n = 14) had normal CFR. In group 1, 14 of 21 had ST-segment depression versus 3 of 14 in group 2 (p < 0.01). Exercise treadmill time (Bruce protocol) was normalized to the age- and sex-predicted time. Exercise time and normalized exercise time were less in group 1 (5.6 +/- 2.3 vs 9.9 +/- 1.8 min and 0.82 +/- 0.32 vs 1.25 +/- 0.23, p < 0.00001). Having either ST-segment depression or a normalized exercise time <1 during exercise had a 95% sensitivity, 71% specificity, and 86% predictive accuracy in identifying abnormal CFR. Coronary stenoses and minimal lumen diameter were similar in groups 1 and 2. By using stepwise logistical regression analysis, exercise time and ST-segment depression predicted CFR with a total r2 of 0.51. Minimal lumen diameter did not significantly add to the model. Exercise test variables, ST-segment depression, and exercise time are predictive of the physiologic significance of coronary lesions.
Schulman
D S
DS
Department of Medicine, Medical College of Pennsylvania, and Hahnemann University, Allegheny General Hospital, Pittsburgh 15212, USA.
Lasorda
D
D
Farah
T
T
Soukas
P
P
Reichek
N
N
Joye
J D
JD
D000368:Aged; D001783:Blood Flow Velocity; D001794:Blood Pressure; D016022:Case-Control Studies; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000295:instrumentation*; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005544:Forecasting; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion / Q000502:physiology; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013997:Time Factors