title: Which variable of stenosis severity best describes the significance of an isolated left anterior descending coronary artery lesion? Correlation between quantitative coronary angiography, intracoronary Doppler measurements and high dose dipyridamole echocardiography.
abstract: OBJECTIVE
  This study sought to investigate the angiographic or intracoronary Doppler variables of stenosis severity that best correlate with the results of dipyridamole echocardiography.
  
  
  BACKGROUND
  Quantitative coronary angiography and intracoronary Doppler flow velocity assessments are the commonly used techniques for the objective identification of significant coronary artery stenosis.
  
  
  METHODS
  Thirty patients with an isolated lesion of the left anterior descending coronary artery (LAD) were studied by means of on-line quantitative coronary arteriography, intracoronary Doppler flow velocity measurements and dipyridamole echocardiography 6 months after percutaneous transluminal coronary angioplasty. The quantitative arteriographic analyses were performed on-line; post-stenotic Doppler flow velocities were measured at baseline and after adenosine infusion. Angiographic and Doppler measurements were compared with the corresponding dipyridamole echocardiographic data and analyzed by discriminant analysis.
  
  
  RESULTS
  The dipyridamole echocardiographic response was positive in 11 patients (37%). The best cutoff values for predicting an abnormal echocardiographic response were 1) stenotic flow reserve of 2.8 (p = 0.0001); 2) 59% diameter stenosis (p = 0.0001); 3) minimal lumen diameter of 1.35 mm (p = 0.001); 4) coronary flow reserve of 2.0 (p = 0.0002); and 5) maximal peak velocity of 60 cm/s during hyperemia (p = 0.04). Multivariate analysis identified stenotic flow reserve as the only independent predictor of ischemia during dipyridamole echocardiography.
  
  
  CONCLUSIONS
  Stenotic flow reserve is the variable that best describes the functional significance of an isolated LAD lesion, and a value of 2.8 is the best predictor of a positive dipyridamole echocardiographic response. Furthermore, angiographic variables of stenosis severity relate to echocardiographic test results better than intracoronary Doppler variables.
authors.affiliation: Department of Cardiology, CNR Institute of Clinical Physiology, Section of Milan, Niguarda Hospital, Italy. ifcnigmi@tin.it
authors.forename: G B
authors.initials: GB
authors.lastname: Danzi
authors.forename: S
authors.initials: S
authors.lastname: Pirelli
authors.forename: L
authors.initials: L
authors.lastname: Mauri
authors.forename: R
authors.initials: R
authors.lastname: Testa
authors.forename: G R
authors.initials: GR
authors.lastname: Ciliberto
authors.forename: D
authors.initials: D
authors.lastname: Massa
authors.forename: A A
authors.initials: AA
authors.lastname: Lotto
authors.forename: L
authors.initials: L
authors.lastname: Campolo
authors.forename: O
authors.initials: O
authors.lastname: Parodi
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D004176:Dipyridamole; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004176:Dipyridamole