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Correlations between coronary flow reserve measured with a Doppler guide wire and treadmill exercise testing
D S Schulman1, D Lasorda, T Farah
1Department of Medicine, Medical College of Pennsylvania, and Hahnemann University, Allegheny General Hospital, Pittsburgh 15212, USA.
American Heart Journal
|July 1, 1997
Summary
Exercise stress tests, including ST-segment depression and reduced exercise time, effectively predict coronary flow reserve (CFR) in patients with coronary artery disease. These findings highlight the value of non-invasive exercise testing for assessing stenosis severity.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Exercise Physiology
Background:
- Coronary artery disease (CAD) diagnosis often relies on assessing stenosis severity.
- Coronary flow reserve (CFR) measured invasively provides a physiologic index of stenosis severity.
- Non-invasive exercise testing is widely used but its correlation with CFR needs further elucidation.
Purpose of the Study:
- To compare exercise test results with invasive CFR measurements in patients with single-vessel coronary disease.
- To determine the predictive value of exercise test variables for abnormal CFR.
- To assess the relationship between ST-segment depression, exercise duration, and CFR.
Main Methods:
- 35 patients with single-vessel CAD underwent exercise testing (Bruce protocol) and CFR measurement using a Doppler guide wire.
- Exercise treadmill time was normalized to age- and sex-predicted values.
- Statistical analysis, including stepwise logistic regression, was used to evaluate predictors of abnormal CFR.
Main Results:
- Patients with abnormal CFR (Group 1) showed significantly higher rates of ST-segment depression (14/21 vs 3/14) and reduced normalized exercise time (0.82 vs 1.25) compared to those with normal CFR (Group 2).
- ST-segment depression or normalized exercise time <1 demonstrated 95% sensitivity and 86% predictive accuracy for abnormal CFR.
- Exercise time and ST-segment depression were significant predictors of CFR (r²=0.51), while minimal lumen diameter was not.
Conclusions:
- Exercise test variables, specifically ST-segment depression and reduced exercise time, are valuable non-invasive predictors of the physiologic significance of coronary stenoses.
- These findings support the utility of exercise stress testing in evaluating the functional impact of coronary lesions.
- Non-invasive exercise parameters can effectively predict abnormal coronary flow reserve, aiding in clinical decision-making.