The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study. Doppler Endpoints Balloon Angioplasty Trial Europe.
BACKGROUND: There are limited data regarding the immediate and long-term effect of balloon angioplasty on the coronary flow reserve evaluated in a multicentre setting. METHODS AND RESULTS: A total of 86 patients with one-vessel disease and normal left ventricular function were analysed before and after optimal balloon angioplasty (diameter stenosis <35%) and at 6-month follow-up. Coronary flow reserve was assessed with a Doppler guide wire. A low coronary flow reserve (<or=2.5) after PTCA, due to an increased baseline blood flow velocity, was encountered in 42 of the 86 patients (49%). Recurrence of angina and target lesion revascularization were more frequent in these patients than in patients with a coronary flow reserve >2.5 (46% vs 23% and 36% vs 16%, respectively; P<0.05) due to a trend towards restenosis (29% vs 16%; P=0.15) or a low coronary flow reserve at follow-up due to persistent elevated baseline blood flow velocity. Patients without restenosis showed a decrease or increase of coronary flow reserve during follow-up, determined by alterations of hyperaemic blood flow velocity. CONCLUSIONS: Patients with an impaired coronary flow reserve directly after optimal balloon angioplasty showed a higher target lesion revascularization rate compared to patients with a coronary flow reserve >2.5. This patient group consists of patients prone to develop restenosis, while other patients are characterized by a persistently low coronary flow reserve, probably secondary to disturbed autoregulation and/or diffuse mild coronary atherosclerosis. Coronary flow reserve alterations in patients without restenosis were related to changes in hyperaemic blood flow velocity, suggesting that this phenomenon relates to epicardial remodelling.
|Keywords||*Angioplasty, Transluminal, Percutaneous Coronary, Adult, Age Factors, Aged, Blood Flow Velocity/*physiology, Chest Pain/physiopathology/therapy/ultrasonography, Cohort Studies, Comparative Study, Coronary Vessels/*physiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Multivariate Analysis, Myocardial Ischemia/physiopathology/therapy/ultrasonography, Predictive Value of Tests, Research Support, Non-U.S. Gov't, Time, Treatment Outcome, Ultrasonography, Doppler|
|Persistent URL||dx.doi.org/10.1053/euhj.2000.2587, hdl.handle.net/1765/12947|
Piek, J.J., Voskuil, M., di Mario, C., Schroeder, J.E., Vrints, C., Probst, P., … Peels, H.O.J.. (2001). The immediate and long-term effect of optimal balloon angioplasty on the absolute coronary blood flow velocity reserve. A subanalysis of the DEBATE study. Doppler Endpoints Balloon Angioplasty Trial Europe.. European Heart Journal, 22(18), 1725–1732. doi:10.1053/euhj.2000.2587