Korean Circ J.  2008 Jun;38(6):325-330. 10.4070/kcj.2008.38.6.325.

Diagnosis of Coronary Restenosis Using Coronary Flow Reserve Measurements Obtained Through Transthoracic Doppler Echocardiography

• Rim SJ
• Ko YG
• Kang SM
• Ha JW
• Choi D
• Jang Y
• Chung N

• KMID: 2225780
• DOI: http://doi.org/10.4070/kcj.2008.38.6.325

Abstract

BACKGROUND AND OBJECTIVES: Coronary flow reserve (CFR) decreases in the presence of significant coronary stenosis. Hence, CFR can be used for the detection of restenosis after percutaneous coronary intervention (PCI). However, because CFR can also be affected by other conditions such as endothelial dysfunction, microvascular damage, and left ventricular hypertrophy, the absolute value of CFR is not routinely used for detection of coronary restenosis. We hypothesized that changes in the value of CFR, rather than the absolute CFR value, are better correlated with restenosis in various clinical settings.
SUBJECTS AND METHODS
We studied 99 patients (71 males/28 females, mean age 58+/-11 years) who underwent successful PCI of the left anterior descending artery. Pre-PCI diagnoses were as follows: 37 unstable angina, 35 stable angina, 27 acute myocardial infarction. CFR using transthoracic Doppler was measured at 48 hours after PCI and at the time of follow-up angiography (6.0+/-1.5 months later). Coronary flow velocity was measured in the distal left anterior descending artery with a 7 MHz transducer (HDI 5,000, Philips, The Netherlands) at baseline and during intravenous infusion of adenosine (140 microgram.kg(-1).min(-1)). Mean diastolic coronary flow velocities from at least three cardiac cycles were averaged.
RESULTS
CFRs in 69 patients without restenosis were 2.55+/-0.99 at 48 hours after PCI and 2.93+/-1.00 at follow-up (p<0.005). CFRs in 30 patients with restenosis (>50% in diameter stenosis) decreased significantly from 2.70+/-1.01 at 48 hours after PCI to 1.98+/-0.91 at follow-up (p<0.001). There was a significant difference in CFR change (ratio of CFR(followup)/CFR(initial)) between the two groups. CFR change had a better receiver operating characteristics (ROC) curve than absolute CFR for prediction of restenosis [area under the curve (AUC) for absolute CFR=0.76, AUC for CFR change=0.82].
CONCLUSION
Restenosis after PCI leads to a significant decrease in CFR, even in the presence of variable baseline CFR values. Serial measurements of CFR can be used to detect restenosis after PCI.

Keyword

Coronary flow reserve; Coronary restenosis; Echocardiography

MeSH Terms

Adenosine
Angina, Stable
Angina, Unstable
Angiography
Area Under Curve
Arteries
Coronary Restenosis
Coronary Stenosis
Echocardiography
Echocardiography, Doppler
Female
Follow-Up Studies
Humans
Hypertrophy, Left Ventricular
Infusions, Intravenous
Myocardial Infarction
Percutaneous Coronary Intervention
Polyenes
ROC Curve
Transducers
Adenosine
Polyenes

Figure

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  Fig. 1 CFR at baseline and follow-up in patients with restenosis and patients without restenosis. CFRs in 69 patients without restenosis were 2.55±0.99 at 48 hours after PCI and 2.93±1.00 at follow-up (p<0.005). CFRs in 30 patients with restenosis (>50% in diameter stenosis) decreased significantly from 2.70±1.01 to 1.98±0.91 (p<0.001). There was a significant difference of CFR in f/u study between two groups. CFR: coronary flow reserve.

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  Fig. 2 The change of CFR in patients with restenosis and patients without restenosis. There was a significant difference of CFR change (ratio of CFRf/u/CFRinitial) between two groups. CFR: coronary flow reserve.

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  Fig. 3 ROC curves for prediction of restenosis using absolute CFR and CFR change. CFR change has better ROC curve than absolute CFR. CFR: coronary flow reserve, AUC: area under the curve, ROC: receiver operating characteristics.

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  Fig. 4 Serial CFRs in patients with restenosis. In patients with relatively high initial CFR, f/u CFR was still high (>2.0) even with restenosis. CFR: coronary flow reserve.

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  Fig. 5 Serial CFRs in patients with no restenosis. In patients with relatively low initial CFR, CFR was still low (≤2.0) even without restenosis. CFR: coronary flow reserve.

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