Intracoronary Doppler assessment of moderate coronary artery disease: Comparison with 201Tl imaging and coronary angiography

Louis I. Heller, Christopher Cates, Jeffrey Popma, Lawrence I. Deckelbaum, James D. Joye, Seth T. Dahlberg, Bernard J. Villegas, Anita Arnold, Robert Kipperman, W. Carter Grinstead, Sharon Balcom, Yunsheng Ma, Michael Cleman, Richard M. Steingart, Jeffrey A. Leppo

Research output: Contribution to journalArticle

131 Citations (Scopus)

Abstract

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 210Tl 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%; κ=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%; κ=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 (κ=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.

Original languageEnglish (US)
Pages (from-to)484-490
Number of pages7
JournalCirculation
Volume96
Issue number2
DOIs
StatePublished - Jul 15 1997
Externally publishedYes

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Coronary Angiography
Coronary Artery Disease
Pathologic Constriction
Doppler Ultrasonography
Exercise
Angiography
Ischemia
Coronary Stenosis
Exercise Test
Coronary Vessels
Heart Rate

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Heller, L. I., Cates, C., Popma, J., Deckelbaum, L. I., Joye, J. D., Dahlberg, S. T., ... Leppo, J. A. (1997). Intracoronary Doppler assessment of moderate coronary artery disease: Comparison with 201Tl imaging and coronary angiography. Circulation, 96(2), 484-490. https://doi.org/10.1161/01.CIR.96.2.484
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. ; Leppo, Jeffrey A. / Intracoronary Doppler assessment of moderate coronary artery disease : Comparison with 201Tl imaging and coronary angiography. In: Circulation. 1997 ; Vol. 96, No. 2. pp. 484-490.
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abstract = "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 210Tl 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{\%}; κ=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{\%}; κ=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 (κ=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.",
author = "Heller, {Louis I.} and Christopher Cates and Jeffrey Popma and Deckelbaum, {Lawrence I.} and Joye, {James D.} and Dahlberg, {Seth T.} and Villegas, {Bernard J.} and Anita Arnold and Robert Kipperman and Grinstead, {W. Carter} and Sharon Balcom and Yunsheng Ma and Michael Cleman and Steingart, {Richard M.} and Leppo, {Jeffrey A.}",
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Heller, LI, Cates, C, Popma, J, Deckelbaum, LI, Joye, JD, Dahlberg, ST, Villegas, BJ, Arnold, A, Kipperman, R, Grinstead, WC, Balcom, S, Ma, Y, Cleman, M, Steingart, RM & Leppo, JA 1997, 'Intracoronary Doppler assessment of moderate coronary artery disease: Comparison with 201Tl imaging and coronary angiography', Circulation, vol. 96, no. 2, pp. 484-490. https://doi.org/10.1161/01.CIR.96.2.484

Intracoronary Doppler assessment of moderate coronary artery disease : Comparison with 201Tl imaging and coronary angiography. / 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.; Leppo, Jeffrey A.

In: Circulation, Vol. 96, No. 2, 15.07.1997, p. 484-490.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Intracoronary Doppler assessment of moderate coronary artery disease

T2 - Comparison with 201Tl imaging and coronary angiography

AU - Heller, Louis I.

AU - Cates, Christopher

AU - Popma, Jeffrey

AU - Deckelbaum, Lawrence I.

AU - Joye, James D.

AU - Dahlberg, Seth T.

AU - Villegas, Bernard J.

AU - Arnold, Anita

AU - Kipperman, Robert

AU - Grinstead, W. Carter

AU - Balcom, Sharon

AU - Ma, Yunsheng

AU - Cleman, Michael

AU - Steingart, Richard M.

AU - Leppo, Jeffrey A.

PY - 1997/7/15

Y1 - 1997/7/15

N2 - 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 210Tl 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%; κ=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%; κ=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 (κ=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.

AB - 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 210Tl 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%; κ=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%; κ=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 (κ=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.

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