Value of coronary stenotic flow velocity acceleration on the prediction of long-term improvement in functional status after angioplasty.
BACKGROUND
The coronary flow velocity acceleration at the stenotic site (SVA), defined as a > or = 50% increase in resting stenotic velocity when compared with the reference segment, has been shown to be highly sensitive and specific for the diagnosis of a hemodynamically significant stenosis. In this study, we describe the value of postprocedural SVA for the prediction of a lack of improvement in functional activity at long-term follow-up balloon angioplasty (BA).


METHODS
We investigated the improvement in functional activity in patients undergoing single native vessel angioplasty and intracoronary Doppler (before BA, after BA, and again at 6-month follow-up) as part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) I trial. Lack of improvement was defined as no change in Duke Activity Status Index (DASI) at 6-month follow-up, whereas SVA was defined as > or = 50% elevation in resting velocity at the treated area compared with the distal measurement.


RESULTS
SVA was found more frequently in patients without improvement in DASI (45% vs 31%, P =.03). Similar percent diameter stenosis and coronary flow velocity reserve were observed in patients with and those without improvement in DASI at follow-up. By multivariate regression analysis, the presence of SVA (P = .029; odds ratio, 1.97; 95% confidence interval, 1.07 to 3.63) and an elevated DASI at baseline (P < .001; odds ratio, 1.05; 95% confidence interval, 1.03 to 1.07) were associated with a lack of improvement at follow-up.


CONCLUSIONS
The detection of SVA was associated with failure of improvement in functional activity at follow-up after coronary intervention.
Albertal
M
M
Thoraxcenter, Amsterdam, The Netherlands.
Regar
E
E
Piek
J J
JJ
Van Langenhove
G
G
Carlier
S G
SG
Thury
A
A
Sianos
G
G
Boersma
E
E
de Bruyne
B
B
di Mario
C
C
Serruys
P W
PW
D000800:Angioplasty, Balloon; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D016896:Treatment Outcome