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Published on: April 13, 2015
Correlations between quantitative cineangiography, coronary flow reserve measured with digital subtraction
F Zijlstra1, P Fioretti, J H Reiber
1Thoraxcenter, Erasmus University, Rotterdam, the Netherlands.
Insights
The calculated pressure drop (PD) best predicts coronary artery stenosis severity compared to diameter stenosis (DS) or obstruction area (OA). Coronary flow reserve (CFR) measurement aids in assessing moderate lesions.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Quantitative Coronary Angiography
Background:
- Assessing the functional significance of coronary artery stenosis is crucial for patient management.
- Anatomical parameters derived from angiography are commonly used but their correlation with functional severity varies.
- Thallium-201 scintigraphy is a functional assessment tool for myocardial perfusion.
Purpose of the Study:
- To determine which anatomical parameter of coronary artery stenosis best correlates with its functional severity.
- To compare the predictive value of calculated pressure drop (PD), percentage diameter stenosis (DS), and cross-sectional area obstruction (OA) against coronary flow reserve (CFR).
Main Methods:
- Thirty-eight patients with single vessel disease underwent coronary cineangiography and exercise/redistribution thallium-201 scintigraphy.
- Quantitative analysis of anatomical parameters: OA, DS, and PD.
- Determination of coronary flow reserve (CFR) using myocardial contrast appearance time and density.
Main Results:
- Calculated pressure drop (PD) showed the strongest correlation with CFR (r=0.90, p<0.001).
- PD demonstrated high predictive accuracy for thallium scintigraphy results (94% sensitivity, 90% specificity).
- PD was a superior anatomical predictor of functional stenosis severity compared to DS and OA.
Conclusions:
- Calculated pressure drop (PD) is a more effective anatomical parameter than DS or OA for assessing the functional importance of coronary stenoses.
- While PD is highly predictive, measuring CFR is valuable for assessing moderately severe lesions due to wide confidence limits.
- Quantitative angiography combined with CFR measurement provides a comprehensive assessment of coronary artery stenosis severity.
Abstract:
The goal of this investigation was to establish which anatomical parameters of stenotic lesions correlate best with its functional severity. Therefore, thirty-eight patients with single vessel disease underwent coronary cineangiography and exercise/redistribution thallium-201 scintigraphy. Cross-sectional area at the site of obstruction (OA), percentage diameter stenosis (DS), the calculated pressuredrop over the stenosis (PD), as well as coronary flow reserve (CFR) derived from myocardial contrast appearance time and density were determined. The relations between CFR and the 3 anatomical parameters were described by the following equations: CFR = 4.6 - 0.053 DS, r = 0.82, SEE: 0.79, p less than 0.001 CFR = 0.5 + 0.75 OA, r = 0.87, SEE: 0.68, p less than 0.001 CFR = 3.6 - 1.5 log PD, r = 0.90, SEE: 0.62, p less than 0.001 The calculated pressuredrop was highly predictive of the thallium scintigraphic results with a sensitivity of 94% and a specificity of 90%. Therefore, the calculated pressuredrop is a better anatomical parameter for assessing the functional importance of a stenosis than percentage diameter stenosis or obstruction area. However, the 95% confidence limits of the relation between pressuredrop and coronary flow reserve are wide, making measurement of CFR a valuable addition to quantitative angiography, especially when determining the functional importance of moderately severe coronary artery lesions.
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