Noninvasive coronary flow reserve assessed by transthoracic coronary Doppler ultrasound in patients with left anterior descending coronary artery stents (original) (raw)
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Journal of Cardiovascular Medicine, 2008
Background Transthoracic Doppler echocardiography is a valuable tool to measure coronary flow reserve (CFR) and detect in-stent restenosis (ISR) after percutaneous coronary angioplasty in selected series of patients. Objectives To assess the usefulness of coronary flow reserve measured by echocardiography in detecting significant (>-70%) ISR of the left anterior descending coronary artery in a large unselected population. Methods Two hundred and twenty-three patients (age 61 W 10 years; 168 men) treated with left anterior descending stenting underwent CFR measurement by transthoracic Doppler echocardiography and venous adenosine infusion 24-72 h before control coronary angiography. Coronary-active drugs were continued, and patients with multiple risk factors and old anterior-apical myocardial infarction were included. Results Significant ISR occurred in 56 patients (25%). Patients with ISR had higher basal coronary flow velocity (27 W 10 cm/s vs. 24 W 7 cm/s; P < 0.002) and lower CFR (1.5 W 0.5 vs. 2.7 W 0.6; P < 0.0001) than those without ISR. A linear relation was found between ISR and CFR (r U S0.73; P < 0.0001) and remained significant after adjustment for blood pressure and heart rate (r U S0.74; P < 0.0001). A CFR less than two identified significant ISR (sensitivity 88%, specificity 88%, area under the curve U 0.943; P < 0.001). In a multivariate model of CFR prediction, myocardial infarction and heart rate were slightly contributory (ß U S0.19, P < 0.01; ß U S0.16, P < 0.03, respectively), whereas ISR had a large influence (ß U S0.66; P < 0.0001). The inverse correlation between ISR and CFR persisted in patients with myocardial infarction (r U S0.64; P < 0.0001) and in those treated with b-blockers (r U S0. 71; P < 0.0001). Conclusion Echocardiographic measurement of CFR detects significant left anterior descending ISR in unselected patients with multiple risk factors, old anteriorapical myocardial infarction, and taking b-blockers.
Global Journal of Health Science, 2015
Measuring fractional flow reserve (FFR) in percutaneous coronary intervention (PCI) has predictive value for PCI outcome. We decided to examine the utility of pre-and post-stenting FFR as a predictor of 6-month stent restenosis as well as MACE (major adverse cardiac events). Pre-and post-stenting FFR values were measured for 60 PCI patients. Within 6 months after stenting, all patients were followed for assessment of cardiac MACE including myocardial infarction, unstable angina, or positive exercise test. Stent restenosis was also assessed. Cutoff values for pre-and post-stenting FFR measurements were considered respectively as 0.65 and 0.92.Stent restenosis was detected in 4 patients (6.6%). All 4 patients (100%) with restenosis had pre-stenting FFR of < 0.65, while only 26 of 56 patients without restenosis (46.4%) had pre-stenting FFR value of < 0.65 (P = 0.039). Mean pre-stenting FFR in patients with restenosis was significantly lower than in those without restenosis (0.25 ± 0.01 vs. 0.53 ± 0.03, P = 0.022). Although stent restenosis was higher in patients with post-stenting FFR of < 0.92 (2 cases, 9.5%) than in those with FFR value of ≥ 0.92 (2 cases, 5.1%), the difference was not statistically (P = 0.510). Pre-stenting FFR, the use of longer stents, and history of diabetes mellitus can predict stent restenosis, but the value of post-stenting FFR for predicting restenosis was not explicit.
New Directions for Community Colleges, 2002
Quantitative coronary angiography (QCA) is routinely used for assessment of strategies aimed at reducing in-stent restenosis. Yet QCA enables only the measurement of luminal variation of stented segments and, unlike intravascular ultrasound (IVUS), provides only an indirect estimation of late in-stent neointimal formation, which has a key role in the process of in-stent restenosis. The aims of the present study were to correlate the IVUS measurement of in-stent intimal hyperplasia (IH) with QCA indexes of restenosis, to find out whether QCA is an adequate surrogate of IVUS, and, using either QCA and IVUS data, to define the sample sizes needed to demonstrate the effectiveness of strategies to reduce in-stent restenosis. The database of the European Imaging Laboratory was used to screen 154 stents implanted between 1997 and 2001 and studied by IVUS at 6 ± 1 months of follow-up. All cases underwent serial QCA assessment (preintervention, postintervention, and follow-up). Only 131 cases with single stent implantation in native coronary arteries were included in the study. Stent restenosis, defined as percent diameter stenosis (DS) > 50%, was present at QCA in 69 out of 131 cases (53%). Linear regression analyses were performed to correlate the amount of IH, calculated by IVUS as the average of all cross-section areas (CSA; mean % IH CSA) and QCA indexes of restenosis (late loss and % DS). A positive significant correlation was found between IVUS mean % IH CSA and QCA % DS (r = 0.74; P < 0.0001) and between IVUS mean % IH CSA and QCA late loss (r = 0.72; P < 0.0001). Based on IVUS measurements of mean % IH CSA, a total sample size of 74 stents would be required in a two-arm comparison to have 0.80 power to detect at 0.05 significant level a 30% difference between two compared groups. Alternatively, adopting the QCA late loss, 230 stents would be required. QCA measurements of late in-stent restenosis are well correlated with IVUS calculation of in-stent neointimal formation. IVUS assessment of IH allows smaller sample sizes than QCA to document significant reductions of in-stent restenosis. Therefore, the use of IVUS should be encouraged in comparison studies aimed at revealing significant neointimal differences in small sample size populations. Cathet Cardiovasc Intervent 2002;57:155–160. © 2002 Wiley-Liss, Inc.
Journal of the American College of Cardiology, 2002
This study sought to evaluate the diagnostic potential of contrast-enhanced transthoracic echocardiography (CE-TTE) during adenosine infusion, a noninvasive method for evaluating coronary flow reserve (CFR), in detecting restenosis after successful percutaneous transluminal coronary angioplasty (PTCA). Restenosis is the most important limitation of PTCA, and CFR can be impaired in patients with angiographically documented significant coronary stenosis. We performed 6 +/- 2 months of follow-up of 53 patients after successful elective PTCA in the left anterior descending coronary artery (LAD). Coronary angiography was performed at the end of the planned follow-up period or even before, if clinically indicated. Thus, of the 53 patients, a total of 63 angiographic studies were performed; CE-TTE assessment of CFR was achieved before each of the 63 angiographic studies. Coronary angiography revealed the presence of restenosis (defined as &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;50% stenosis at a previous PTCA site) in 32 angiographic examinations (group A) and no coronary restenosis in the remaining 31 examinations (group B). Coronary flow reserve was significantly reduced in group A compared with group B (1.65 +/- 0.5 vs. 3.17 +/- 0.8, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 0.001). A noninvasive CFR value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; or = 2 was 93% specific and 78% sensitive for detecting significant restenosis, with positive and negative diagnostic accuracies of 92% and 80%, respectively. Noninvasive CFR assessment by CE-TTE is an accurate method of monitoring significant restenosis in the LAD when following up patients submitted to elective PTCA.
The American Journal of Cardiology, 2011
Despite the widespread adoption of drug-eluting stent (DES) implantation, the optimal treatment of DES failures remains challenging. The present study evaluated the relation between quantitative angiography and the fractional flow reserve (FFR) in restenotic lesions after DES implantation and the efficacy of FFR in determining whether to treat these lesions. To assess their functional significance, the coronary pressure-derived FFR was measured in 50 DES restenotic lesions (49 patients). Additional intervention was performed in lesions with a FFR <0.8. Major adverse cardiac events were assessed at 12 months after the reintervention procedure. The mean percent diameter stenosis (%DS) was 58 ؎ 13%. Of the 50 lesions, 20 (40%) were deferred without additional intervention. The FFR and %DS had a negative correlation (r ؍ ؊0.61, p <0.001). However, when only the lesions with diffuse-type restenosis (15 lesions) were analyzed, the degree of correlation decreased (r ؍ ؊0.56, p ؍ 0.12). Although most lesions (89%) with a %DS of >70 had significant functional ischemia, among 41 lesions with a %DS <70, only 20 (49%) had demonstrated functional patency. The incidence of adverse events during the 12 months of follow-up after FFR-guided treatment was 18.0% (23.3% in the FFR <0.80 group and 10.0% in FFR >0.80 group). In conclusion, a discrepancy was found between functional ischemia measured by the FFR and the angiographic %DS, in particular, in moderate-or diffuse-type restenotic lesions after DES implantation. The outcome of FFR-guided deferral in patients with DES in-stent restenosis seems favorable.
Catheterization and Cardiovascular Interventions, 1999
While quantitative coronary angiography (QCA) remains the standard used to assess new interventional therapies, intracoronary ultrasound (ICUS) is gaining interest. The aim of the study was to determine the relationship between QCA and quantitative coronary ultrasound (QCU) measurements after stenting. Sixty-two consecutive patients with both QCA and QCU analysis after stent implantation were included in the study. The mean luminal diameter (QCU vs. QCA) were 2.74 ؎ 0.46 mm and 2.41 ؎ 0.49 mm (P F 0.0001), the minimal luminal diameter (MLD) 2.08 ؎ 0.44 mm and 1.62 ؎ 0.42 mm (P F 0.0001), and the projected QCU MLD 1.90 ؎ 0.42 mm (P F 0.0001 with respect to QCA). Percentage obstruction diameter (QCU vs. QCA) were 41.53% ؎ 10.78% and 43.15% ؎ 12.72% (P ؍ NS). The stent diameter (QCU vs. QCA) were 3.54 ؎ 0.65 mm and 3.80 ؎ 0.37 mm (P ؍ 0.0004). Stent length measured by QCU were longer at 31.11 ؎ 13.54 mm against 28.63 ؎ 12.75 mm, P F 0.0001 with respect to QCA. In conclusion, while QCA and QCU appear to be comparable tools for measuring corrected stent diameters and stent lengths, smaller luminal diameters were found using QCA. This is of particular relevance to quantitative studies addressing absolute changes in vascular or luminal diameters. Cathet. Cardiovasc. Intervent. 48:133-142, 1999.