title: Comparison of coronary flow velocity reserve measurement by transthoracic Doppler echocardiography with 320-row multidetector computed tomographic coronary angiography in the detection of in-stent restenosis in the three major coronary arteries.
abstract: We sought to compare the diagnostic accuracy and feasibility of coronary flow velocity reserve (CFVR) measurement using transthoracic Doppler echocardiography (TTDE) and 320-row multidetector computed tomographic coronary angiography (CTCA) for predicting in-stent restenosis (ISR). We enrolled 126 consecutive patients with 309 implanted coronary stents in the 3 major coronary arteries. TTDE and CTCA were performed within the 2-week period before follow-up invasive coronary angiography. Binary ISR was defined as percent diameter stenosis ≥50% on invasive coronary angiogram. A CFVR <2.0 using TTDE and a narrowing of ≥50% measured with CTCA were the thresholds indicating the presence of binary ISR. Presence of ISR using invasive coronary angiography was observed in 26 (8%) stents and 26 (14%) vessels. Feasibilities of CFVR measurement and CTCA for predicting ISR in the 3 major vessels were 94% and 91%, respectively. A CFVR <2.0 revealed a 95% diagnostic accuracy with sensitivity of 87%, specificity of 96%, positive predictive value of 77%, and negative predictive value of 98%. Diagnostic accuracy of CTCA was comparable to that of CFVR measurement; however, CTC angiographic results were confounded by metal artifacts in the assessment of small-diameter stents. In conclusion, noninvasive CFVR measurement has high feasibility and accuracy for predicting ISR and is comparable to 320-row CTCA.
authors.affiliation: Department of Cardiology, Yokkaichi Social Insurance Hospital, Yokkaichi, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kakuta
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yamada
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamanaka
authors.forename: Masaki
authors.initials: M
authors.lastname: Kawamura
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamori
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanigawa
authors.forename: Katsuya
authors.initials: K
authors.lastname: Onishi
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.forename: Mashio
authors.initials: M
authors.lastname: Nakamura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nobori
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015150:Echocardiography, Doppler / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015607:Stents