The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study. Doppler Endpoints Balloon Angioplasty Trial Europe.
BACKGROUND
There are limited data regarding the immediate and long-term effect of balloon angioplasty on the coronary flow reserve evaluated in a multicentre setting.


RESULTS
A total of 86 patients with one-vessel disease and normal left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis <35%) and at 6-month follow-up. Coronary flow reserve was assessed with a Doppler guide wire. A low coronary flow reserve (<or=2.5) after PTCA, due to an increased baseline blood flow velocity, was encountered in 42 of the 86 patients (49%). Recurrence of angina and target lesion revascularization were more frequent in these patients than in patients with a coronary flow reserve >2.5 (46% vs 23% and 36% vs 16%, respectively; P<0.05) due to a trend towards restenosis (29% vs 16%; P=0.15) or a low coronary flow reserve at follow-up due to persistent elevated baseline blood flow velocity. Patients without restenosis showed a decrease or increase of coronary flow reserve during follow-up, determined by alterations of hyperaemic blood flow velocity.


CONCLUSIONS
Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve >2.5. This patient group consists of patients prone to develop restenosis, while other patients are characterized by a persistently low coronary flow reserve, probably secondary to disturbed autoregulation and/or diffuse mild coronary atherosclerosis. Coronary flow reserve alterations in patients without restenosis were related to changes in hyperaemic blood flow velocity, suggesting that this phenomenon relates to epicardial remodelling.
Piek
J J
JJ
Department of Cardiology, Academical Medical Center, Amsterdam, The Netherlands.
Boersma
E
E
Voskuil
M
M
di Mario
C
C
Schroeder
E
E
Vrints
C
C
Probst
P
P
de Bruyne
B
B
Hanet
C
C
Fleck
E
E
Haude
M
M
Verna
E
E
Voudris
V
V
Geschwind
H
H
Emanuelsson
H
H
Mühlberger
V
V
Peels
H O
HO
Serruys
P W
PW
D000328:Adult; D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001783:Blood Flow Velocity / Q000502:physiology*; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D003331:Coronary Vessels / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D013995:Time; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler