Key result
A coronary flow reserve < 2 measured by transesophageal Doppler echocardiography predicted restenosis after PTCA with a sensitivity of 88.9% and specificity of 95.2%.
Why the study?
Does serial evaluation of coronary flow reserve by transesophageal Doppler echocardiography accurately detect restenosis after PTCA of the proximal LADA?
Observational (n=30)
Does serial evaluation of coronary flow reserve by transesophageal Doppler echocardiography accurately detect restenosis after PTCA of the proximal LADA?
Effect estimate: Sensitivity 88.9%, Specificity 95.2%
Absolute Event Rate: 88.9% vs 4.8%
Transesophageal Doppler echocardiography can serially evaluate coronary flow reserve after PTCA, with a CFR > 2 accurately predicting the absence of restenosis.
May support serial noninvasive restenosis surveillance after PTCA; leaves open need for prospective validation before practice change.
BACKGROUND: Coronary flow reserve can be estimated by transesophageal Doppler echocardiography (TDE). OBJECTIVE: To evaluate the coronary flow reserve by TDE, serially over 6 months' follow-up, after successful percutaneous transluminal coronary angioplasty (PTCA) of proximal left anterior descending coronary artery (LADA). METHODS AND RESULTS: We performed TDE examination of 30 patients (mean age 55 +/- 9 years) 72 h, 3 months, and 6 months after PTCA of LADA. Selective angiography of LADA was repeated 72 h and 6 months after PTCA of LADA. Velocity of flow in LADA was measured before and 2 min after cessation of intravenous infusion of dipyridamole (0.56 mg/kg in 4 min). The dipyridamole: rest mean diastolic velocity ratio was considered as an index of coronary flow reserve (CFR). For 20 of 21 patients with CFR > 2 there was no restenosis, whereas coronary angiography revealed restenosis in eight of nine patients with CFR < 2. The sensitivity was 88.9% and the specificity was 95.2%. For the 21 patients without restenosis mean CFR was 2.1 +/- 0.1 72 h after PTCA, had increased to 3.1 +/- 0.3 (P < 0.0001) 3 months after PTCA, and remained stable thereafter (3.0 +/- 0.9). CONCLUSION: CFR after PTCA of proximal LADA can be evaluated serially by transesophageal Doppler echocardiography. CFR of LADA in patients without restenosis is increased 3 months after PTCA and remains stable thereafter.
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Paraskevaidis et al. (2001) conducted an observational in Post-percutaneous transluminal coronary angioplasty of proximal left anterior descending coronary artery (n=30). Coronary flow reserve (CFR) < 2 by transesophageal Doppler echocardiography vs. CFR > 2 was evaluated on Restenosis on coronary angiography (Sensitivity 88.9%, Specificity 95.2%). A coronary flow reserve < 2 measured by transesophageal Doppler echocardiography predicted restenosis after PTCA with a sensitivity of 88.9% and specificity of 95.2%.
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