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Clinical Investigations: CARDIOLOGY |

Relative Coronary Flow Velocity Reserve Improves Correlation With Stress Myocardial Perfusion Imaging in Assessment of Coronary Artery Stenoses*

Vassilis Voudris; Dimitrios Avramides; Maria Koutelou; John Malakos; Athanasios Manginas; Manolis Papadakis; Dennis V. Cokkinos
Author and Funding Information

*From the First Cardiology Department, Onassis Cardiac Surgery Center (Drs. Voudris, Avramides, Malakos, Manginas, Papadakis, and Cokkinos), and Nuclear Medicine Department (Dr. Koutelou), Athens, Greece.

Correspondence to: Vassilis Voudris, MD, First Cardiology Department, Onassis Cardiac Surgery Center, 356 Sygrou Ave, 176 74 Athens, Greece; e-mail: vvoudris@otenet.gr



Chest. 2003;124(4):1266-1274. doi:10.1378/chest.124.4.1266
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Study objective: To evaluate the angiographic and coronary flow velocity parameters that best correlate with the results of stress myocardial perfusion imaging.

Design: Criterion standard.

Setting: Tertiary care center.

Patients: Forty-eight patients undergoing diagnostic coronary angiography for angina or silent ischemia.

Interventions: We performed angiographic and coronary flow velocity measurements at rest and during hyperemia at the post-stenotic segment and in the adjacent angiographically normal branch of the left coronary artery. Relative coronary flow velocity reserve (RCFVR) was calculated as the ratio of post-stenotic to reference vessel coronary flow velocity reserve (CFVR). The best cutoff points for reversible perfusion defects were calculated using receiver operating characteristic curves.

Measurements and results: Post-stenotic CFVR showed fairly good correlations with minimal lumen diameter and percentage of diameter stenosis (r = 0.57 and r = 0.55, respectively; p < 0.001). RCFVR showed stronger correlations with these angiographic indexes of stenosis severity (r = 0.66 and r = 0.68, respectively; p < 0.0001). Based on receiver operating characteristic cutoff values (1.67 for post-stenotic CFVR and 0.64 for RCFVR), RCFVR had better agreement with myocardial perfusion imaging results, compared to post-stenotic CFVR (92% vs 75%, respectively). This agreement was more meaningful in patients with moderate coronary artery stenoses (50 to 75%). The area under the curve was 0.65 (not significant) for post-stenotic CFVR and 0.88 (p < 0.01) for RCFVR.

Conclusions: RCFVR describes better than post-stenotic CFVR the functional significance of coronary artery stenoses.

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