Subselective Measurement of Coronary Blood Flow Velocity Using a Steerable Doppler Catheter (original) (raw)
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Validation study of a Doppler-tipped angiographic catheter for measurement of coronary flow reserve
American Journal of Cardiology, 1993
investigators." Jaffe5 analyzed postexercise electrocardiograms in men and women treated with estrogen-progesterone therapy and reported an increase in postexercise STlsegment changes as high as 90% in the treated subjects. Similar to 'the present study, bilateral oophorectomy affects exercise-induced ST-segment depression in young women with low prevalence of ischemic heart disease. A special effort was made to rule out active ischemia. Because the operative procedure was identical for both groups, the only difference between the 2 groups was the presence of sex hormones in the unilateral oophorectomy group and their absence in the bilateral oophorectomy group. Each woman served as her own control before and after the operation, and only complete disappearance of $the exercise-induced clear-cut Y mm preoperative ST-segment depression at the same double product was considered a genuine change after surgery.
Maximal blood flow velocity in severe coronary stenoses measured with a Doppler guidewire
The American Journal of Cardiology, 1993
In vitro and animal experiments have shown that the severity of coronary stenoses can be assessed using the continuity equation If the maximal blood flow velocity of the stenotk Jet is measured. The large diameter and the low range of velocities measurable without frequency aliasing with the conventional intracoronary Doppler catheters precluded the cllnkal applkation of this method for hemodynamkally signifkant coronary stenoses in humans. This artkk reports the resutts obtained using a l2 MHz steerable angioplasty guidewlre in a consecutive series of 52 patients undergoing percutaneous coronary anglopla!sty(6lcoronatyst-).Theratiobe-tweencoronaryflowvelocityinaMerenceseg= ment and In the stenosis was used to estimate the percent cross-sectional area stenosis. A Doppler recording suitable for quantization was obtained in the stenotk segment in only l0 of 61 arteries (l6%). The time-averaged peakvekcity increasedfroml5+5toll5+26cm/secfrom thereferencenormalsegmenttothestenosls. Volumetrk coronary flow cakulated from the productofmeanflowvelodty and cro!m-sectional area was similar in the stenosis and in the referencesegment(33.2 -c 14.9vs33.5 Jt 17.0 mL/ min, respectively, dWerence not significant). The m cross-sectional area stenosis and minimal luminal cross-sectional ac88 derived from the Doppler velocity measurements u!&g the continuity equation and calculated with quantitative angiography were also similar (Doppler, 66.7 + . 5.1% and LOO f 0.46 mm2; quantitathfe angiography, 65.9 -c 7.9% and 102 + 0.50 mmZ). A signifkant correlatii was observed between Doppler-derived and angkgraphk measu (percent cross-sectknal area: r = O.Z,zW minhnal cross-sectional area: r = 0.69, p CO.05). Although the percent cross-sectional area stenosis and minimal cross-sectlonal area derived from the Doppler measurements basedonthe continuityequationweresignHkantlywwekted wfth the corresponding quantitative anglographk measurements,thisdeterminatioocouldbe achieved in a minority of cases (l6%), limttlng the practkal applkatkn of this approach for the aswssmentof coronafystenosisseverity.
Assessment of angiographically intermediate coronary artery stenosis using the Doppler flowire
The American Journal of Cardiology, 1993
Determinatfon of the clinkal and hemodynamk slgnWicance of coronary stenoses is often dtfflcult and inexact. Angiography and coronary vase. dilator reserve have heen shown to be Imperfect took to determine the physfokgk stgnlfkance of coronafystenows.8pectralflowve~nydata, both proximal and distal to coronary stenoses, using an 0.0~in intra -w Doppkr-tipped angkpbty guidewtre, were compared to transksional pressure gradients and angkgraphy during cardiac -ion.
The American Journal of Cardiology, 1993
In vitro and animal experiments have shown that the severity of coronary stenoses can be assessed using the continuity equation If the maximal blood flow velocity of the stenotk Jet is measured. The large diameter and the low range of velocities measurable without frequency aliasing with the conventional intracoronary Doppler catheters precluded the cllnkal applkation of this method for hemodynamkally signifkant coronary stenoses in humans. This artkk reports the resutts obtained using a l2 MHz steerable angioplasty guidewlre in a consecutive series of 52 patients undergoing percutaneous coronary anglopla!sty(6lcoronatyst-).Theratiobe-tweencoronaryflowvelocityinaMerenceseg= ment and In the stenosis was used to estimate the percent cross-sectional area stenosis. A Doppler recording suitable for quantization was obtained in the stenotk segment in only l0 of 61 arteries (l6%). The time-averaged peakvekcity increasedfroml5+5toll5+26cm/secfrom thereferencenormalsegmenttothestenosls. Volumetrk coronary flow cakulated from the productofmeanflowvelodty and cro!m-sectional area was similar in the stenosis and in the referencesegment(33.2 -c 14.9vs33.5 Jt 17.0 mL/ min, respectively, dWerence not significant). The m cross-sectional area stenosis and minimal luminal cross-sectional ac88 derived from the Doppler velocity measurements u!&g the continuity equation and calculated with quantitative angiography were also similar (Doppler, 66.7 + . 5.1% and LOO f 0.46 mm2; quantitathfe angiography, 65.9 -c 7.9% and 102 + 0.50 mmZ). A signifkant correlatii was observed between Doppler-derived and angkgraphk measu (percent cross-sectknal area: r = O.Z,zW minhnal cross-sectional area: r = 0.69, p CO.05). Although the percent cross-sectional area stenosis and minimal cross-sectlonal area derived from the Doppler measurements basedonthe continuityequationweresignHkantlywwekted wfth the corresponding quantitative anglographk measurements,thisdeterminatioocouldbe achieved in a minority of cases (l6%), limttlng the practkal applkatkn of this approach for the aswssmentof coronafystenosisseverity.
1993
In vitro and animal experiments have shown that the severity of coronary stenoses can be assessed using the continuity equation If the maximal blood flow velocity of the stenotk Jet is measured. The large diameter and the low range of velocities measurable without frequency aliasing with the conventional intracoronary Doppler catheters precluded the cllnkal applkation of this method for hemodynamkally signifkant coronary stenoses in humans. This artkk reports the resutts obtained using a l2 MHz steerable angioplasty guidewlre in a consecutive series of 52 patients undergoing percutaneous coronary anglopla!sty(6lcoronatyst-).Theratiobe-tweencoronaryflowvelocityinaMerenceseg= ment and In the stenosis was used to estimate the percent cross-sectional area stenosis. A Doppler recording suitable for quantization was obtained in the stenotk segment in only l0 of 61 arteries (l6%). The time-averaged peakvekcity increasedfroml5+5toll5+26cm/secfrom thereferencenormalsegmenttothestenosls. Volumetrk coronary flow cakulated from the productofmeanflowvelodty and cro!m-sectional area was similar in the stenosis and in the referencesegment(33.2 -c 14.9vs33.5 Jt 17.0 mL/ min, respectively, dWerence not significant). The m cross-sectional area stenosis and minimal luminal cross-sectional ac88 derived from the Doppler velocity measurements u!&g the continuity equation and calculated with quantitative angiography were also similar (Doppler, 66.7 + . 5.1% and LOO f 0.46 mm2; quantitathfe angiography, 65.9 -c 7.9% and 102 + 0.50 mmZ). A signifkant correlatii was observed between Doppler-derived and angkgraphk measu (percent cross-sectknal area: r = O.Z,zW minhnal cross-sectional area: r = 0.69, p CO.05). Although the percent cross-sectional area stenosis and minimal cross-sectlonal area derived from the Doppler measurements basedonthe continuityequationweresignHkantlywwekted wfth the corresponding quantitative anglographk measurements,thisdeterminatioocouldbe achieved in a minority of cases (l6%), limttlng the practkal applkatkn of this approach for the aswssmentof coronafystenosisseverity.
Clinical Applications of the Doppler Coronary Flow Velocity Guidewire for Interventional Procedures
Journal of Interventional Cardiology, 1993
The development of a subselective coronary Doppler catheter coupled with pharmacologic coronary resistance vessel vasodilation has enabled clinicians to assess coronary vasodilator reserve in humans. This technique has proven useful in the clinical management of patients with a variety of cardiologic problems. This review describes usefulness of Doppler measurements of coronary flow reserve for (1) functional assessment of coronary stenoses of intermediate severity; (2) determination of the need for lesion-specific interventional therapy; (3) assessment of the severity of saphenous vein bypass graft and graft-native vessel anastomotic lesions; (4) assessment of the coronary microcirculation.
Assessing Coronary Flow Physiology with Intracoronary Doppler Following Coronary Interventions
Journal of Interventional Cardiology, 1996
Altholrgh coronary angiography has been the gold standard for assessing coronary artery stenoses, it yields information prirnarilji about the anatomical severity of coronary artery disease, which frequently does not correlate with its physiological severity. Coronary interventions (PTCA, utherectomy, laser, etc.) are peiformedprimarily to improve coronary flow physiology. Coronary flow physiology may be a more important end point than angiolyaphy following coronary interventions that were pevformed to normalize coronary flow physiology. In uddition, the physiologicul significance of angiogruphically intermediute stenoses should be assessed before proceeding with cirtheter-based revascularization. Currently, the Doppler guidewire is available for routine c,linircil assessment of coronary flow physiology in the Cardiac Catheterizution Lab. Several Doppler measurenients have been used to assess the physiological effect of a stenosis, including the diastolic-systolic velocity ratio, proximal-distal velocity ratio, cwronar-y flow reserve, continuity equation, and the hyperemic diastolic presslrre-flow relalionship. The Doppler derived coronary flow reserve correlates highly with stress nuclear perfusion images. These Doppler nieasurements have been made following PTCA, directional atherectomy, rotational atherectomy, and excimer laser. Following coronary interventions. adverse clinical events may be predicted i f ther.e is impaired flow physiology or cyc,lic, flow variations. Muny of the Doppler measurements used for assessing the lesion severity remain abnormal following successful coronary intenmtions for reasons unrelated to the lesion. Conversely, normalization of coronary physiology does not guarantee an adequate anatoniical result. Further clinical trials will provide a more complete definition of the exuct role for coronary flow velociv assessnient following coronary interventions.
Clinical applications of Doppler coronary flow reserve measurements
The American Journal of Cardiology, 1993
Dop-plercathetercoupiedwithphamlaco~coro-naryresistancevesselvasodUationhasenabled dinkians to assess coronaryvasodilatof reserve in humans. This technique has proven useful in the dlnkal management of patients with a vari-etyOfWdOklgkprOblems.ThlS-d6-scribesusefulnessefDeppler meawrementsef ceronary flow reserve for functional assessmentofcoronarystenoses of intermediate se-ve4rity;(2)dehrminatknoftheneedforlesknfspecm intervent#enal therapy; (3) asse!Bsment of the severity of saphenous vdn bypass graft andgraftaative vessel anastomotic lesions; (4) asumamM of the cetmaty microcirculation.
The American Journal of Cardiology, 1993
Quantitation of coronary collateral flow in patients has been limited to angiographk techniques, whkh are subJect to well-known methodologk limitations. The use of a Doppler-tipped angioplastyguidewirepermltsmeasurementof both antegrade and MrogrAe flow distal to totally or subtotally occluded vesseis that may be supplied with acutely recruitable or angiographitally mature collateral conduits. Using coronary fkwvdocity as an imlkator of collateral flow, Mrogrx& flow vekcity was quantitated in 17 pathts.