Key result
Six months after successful coronary angioplasty without restenosis, patients with myocardial perfusion defects had significantly lower coronary flow reserve (2.11 vs 2.87, p<0.002) and reduced peak dobutamine myocardial systolic function compared to those with normal perfusion.
Cross-Sectional (n=24)
Single-blind
Absolute Event Rate: 2.11% vs 2.87%
p-value: p=<0.002
Perfusion defects after successful angioplasty may signal microvascular impairment; this Level 3 finding leaves open whether CFR assessment changes management.
After percutaneous transluminal coronary angioplasty (PTCA), stress-echocardiography and gated single photon emission computerized tomography (g-SPECT) are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD) six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR) and color Tissue Doppler (C-TD) dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio) and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm) and diastolic (Em and Am, Em/Am ratio) peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI) and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 +/- 0.4 versus 2.87 +/- 0.6, p < 0.002) and septal Sm at high-dose dobutamine (p < 0.01), with higher WMSI (p < 0.05) and stress-echo positivity of LAD territory in 5/11 patients. In the overall population, CFR was related negatively to high-dobutamine WMSI (r = -0.50, p < 0.01) and positively to high-dobutamine Sm of middle septum (r = 0.55, p < 0.005). In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD.
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Cicala et al. (2004) conducted a cross-sectional in Coronary artery disease post-PTCA (n=24). Myocardial perfusion defects vs. Normal perfusion was evaluated on Coronary flow reserve (CFR) (p=<0.002). Six months after successful coronary angioplasty without restenosis, patients with myocardial perfusion defects had significantly lower coronary flow reserve (2.11 vs 2.87, p<0.002) and reduced peak dobutamine myocardial systolic function compared to those with normal perfusion.
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