Intracoronary Doppler assessment of moderate coronary artery disease: comparison with 201Tl imaging and coronary angiography. FACTS Study Group
Department of Medicine, Division of Preventive and Behavioral Medicine; Department of Medicine, Division of Cardiovascular Medicine; Division of Nuclear Medicine
Aged; *Coronary Angiography; Coronary Circulation; *Coronary Disease; Female; Humans; Male; Middle Aged; *Tomography, Emission-Computed, Single-Photon; *Ultrasonography, Doppler
Cardiology | Cardiovascular Diseases | Preventive Medicine
BACKGROUND: Coronary angiography may not reliably predict whether a stenosis causes exercise-induced ischemia. Intracoronary Doppler ultrasound may enhance diagnostic accuracy by providing a physiological assessment of stenosis severity. The goal of this study was to compare intracoronary Doppler ultrasound with both 201Tl imaging and coronary angiography.
METHODS AND RESULTS: Fifty-five patients with 67 stenotic coronary arteries underwent coronary angiography with intracoronary Doppler ultrasound and had exercise 201Tl testing within a 1-week period. Coronary flow reserve was measured, and analyses were performed by independent core laboratories. The mean stenosis was 59+/-12%; 51 of 67 stenoses were intermediate in severity (40% to 70%). A coronary flow reserve < 1.7 predicted the presence of a stress 201Tl defect in 56 of 67 stenoses (agreement=84%; kappa=0.67; 95% CI=0.48 to 0.86). In the patients who achieved 75% of their predicted maximum heart rate, the Doppler and 201Tl imaging data agreed in 46 of 52 stenoses (agreement=88%; kappa=0.77; 95%CI=0.57 to 0.97). Scatter was evident when angiography was compared with coronary flow reserve (r=.43), and the angiogram did not reliably predict the results of the 201Tl stress test (kappa=0.21; agreement=57% to 63%).
CONCLUSIONS: Doppler-derived coronary flow reserve accurately predicts the presence of exercise-induced ischemia on stress 201Tl imaging, and coronary angiography does not reliably assess the physiological significance of an intermediate coronary stenosis.
Circulation. 1997 Jul 15;96(2):484-90.
Heller, Louis I.; Cates, Christopher; Popma, Jeffrey; Deckelbaum, Lawrence I.; Joye, James D.; Dahlberg, Seth T.; Villegas, Bernard J.; Arnold, Anita; Kipperman, Robert; Grinstead, W. Carter; Balcom, Sharon; Ma, Yunsheng; Cleman, Michael; Steingart, Richard M.; and Leppo, Jeffrey A., "Intracoronary Doppler assessment of moderate coronary artery disease: comparison with 201Tl imaging and coronary angiography. FACTS Study Group" (1997). Preventive and Behavioral Medicine Publications and Presentations. 26.