Measurement of coronary flow velocity with Doppler catheter: evaluation of coronary flow reserve in successful angioplasty

To assess the therapeutic effect of percutaneous transluminal coronary angioplasty (PTCA) on coronary flow reserve, coronary flow velocity (CFV) was measured with a Doppler catheter before and immediately after PTCA in 11 patients, who underwent elective PTCA for critical stenosis in proximal or mid portion of the left anterior descending artery (LAD). A Doppler catheter was positioned at the proximal portion of the LAD and the CFV was measured at rest and after intracoronary injection of 6 ml of contrast material (Iopamidol), 6 ml of saline or 3 mg of Isosorbide Dinitrate (ISDN). Peak to resting velocity ratio (PRVR) was calculated as an estimate of coronary flow reserve. Percent diameter stenosis (%S) was measured from cineangiogram. A translesional pressure gradient was obtained with an angioplasty catheter. These parameters measured in PTCA candidates were compared with those in 11 patients whose LAD had no critical stenosis. After PTCA, %S was decreased (94.2 +/- 1.4 vs 34.1 +/- 5.1%; mean +/- SEM). Pressure gradient was also decreased (59.5 +/- 4.9 vs. 25.1 +/- 3.3 mmHg). There was no difference between mean CFV at rest in patients before PTCA and that in patients without stenosis (4.52 +/- 0.63 vs. 5.46 +/- 0.61 cm/sec). By successful PTCA, CFV at rest was increased (7.39 +/- 1.32, p less than 0.05 vs. before PTCA). PRVRs in patients before PTCA were smaller than those in patients without stenosis (1.5 +/- 0.1, 1.4 +/- 0.1, 1.6 +/- 0.2 vs. 2.8 +/- 0.1, 2.5 +/- 0.2, 2.8 +/- 0.2, p less than 0.01; by contrast material, saline, ISDN, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)