Document Detail


Simultaneous Doppler and pressure recordings to assess microvascular dysfunction in chronic total coronary occlusions--potential for recovery during follow-up.
MedLine Citation:
PMID:  12641026     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Microvascular dysfunction (MD) is frequently observed in chronic total coronary occlusions (TCOs). This impairs the use of Doppler velocimetry for the guidance of PTCA. It is yet unknown to what extent microvascular dysfunction may recover during follow-up, and whether this may influence long-term outcome. METHODS: After recanalization and stenting of TCOs (duration > 4 weeks) in 56 patients, coronary flow velocity reserve (CFVR) and fractional flow reserve (FFR) were recorded. MD was defined as a CFVR < 2.0 in the absence of a significant epicardial lesion (FFR > or = 0.75). Patients were followed for 5.3 +/- 1.5 months with reassessment of CFVR, FFR, and of LV function during a repeat angiography. RESULTS: MD was observed in 50% after PTCA. The CFVR improved during follow-up from 1.93 +/- 0.62 to 2.35 +/- 0.69 (p < 0.001), with a decrease of baseline APV (31.0 +/- 13.6 cm/s to 25.7 +/- 15.0 cm/s; p = 0.022). At follow-up MD was observed less frequently (20%). In 20 of 36 patients with initially impaired LV function, the ejection fraction (LVEF) improved. The CFVR at baseline did not predict LV recovery. Target vessel failure (restenosis > 50% diameter stenosis) occurred in 43%. CFVR did not predict TVF, but FFR tended to be lower in patients with TVF. In 8 patients with FFR > or = 0.93 after recanalization, no TVF was required. CONCLUSIONS: MD improved in more than 50% with initially impaired MD after PTCA during a long-term follow-up. CFVR at baseline was not closely related to LV recovery. The high rate of TVF was not predictable by CFVR. The FFR may be more valuable for optimizing PTCA in TCOs than Doppler parameters.
Authors:
Gerald S Werner
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Zeitschrift für Kardiologie     Volume:  91 Suppl 3     ISSN:  0300-5860     ISO Abbreviation:  Z Kardiol     Publication Date:  2002  
Date Detail:
Created Date:  2003-03-18     Completed Date:  2003-03-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0360430     Medline TA:  Z Kardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  120-5     Citation Subset:  IM    
Affiliation:
Klinik für Innere Medizin III, Friedrich-Schiller-Universität, Erlanger Allee 101, 07740 Jena, Germany. gerald.werner@med.uni-jena.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Analysis of Variance
Angioplasty, Transluminal, Percutaneous Coronary*
Blood Pressure*
Coronary Circulation*
Coronary Disease / physiopathology*,  therapy*
Data Interpretation, Statistical
Female
Follow-Up Studies
Humans
Laser-Doppler Flowmetry*
Male
Microcirculation
Middle Aged
Risk Assessment
Time Factors
Treatment Outcome
Ventricular Function, Left / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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