http://repub.eur.nl/res/aut/1043/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/24282/ 2009-09-01T00:00:00Z Background: A retrospective, single-center 4-year clinical study of the off-pump coronary artery bypass grafting no-touch technique with arterial conduits (Y-graft) was compared with the Syntax trial. Methods: Four hundred consecutive patients ("all-comers") who underwent coronary surgery between 2004 and 2008 at the Thorax Center Twente (TCT) formed the study group. The primary end point was in-hospital and 12-month major cardiovascular or cerebrovascular event (MACCE). Event rates of MACCE were based on life tables, and overall MACCE was determined by Kaplan-Meier analysis. Results: In-hospital mortality was 0.2%. Cumulative 1-year survival was 98.2%, and freedom from MACCE was 94.7% ± 1.1%. Cumulative 4-year survival and freedom from MACCE were 91.2% ± 2.4% and 82.1% ± 3.0%, respectively. There were no significant differences in the baseline characteristics between the patients of the TCT group and the surgical arm of the Syntax trial. Repeat revascularization, MACCE, and symptomatic graft occlusion in the TCT group were significantly lower than in the Syntax trial. The event rate of myocardial infarction and all-cause death in the TCT group were significantly lower than those of the percutaneous coronary intervention arm of the Syntax trial. There was a clear trend toward a reduction of the event rate of stroke in the TCT group (0.8%) compared with the surgical arm of the Syntax trial (2.2%). There was no significant difference of stroke rate between the TCT group and the percutaneous coronary intervention arm of the Syntax trial. Conclusions: A state-of-the-art surgical technique such as off-pump coronary artery bypass grafting no-touch can further improve the advantage of surgical treatment with respect to percutaneous coronary intervention. Off-pump coronary artery bypass grafting no-touch surgery can be the treatment of choice for patients with three-vessel disease and left main stenosis. http://repub.eur.nl/res/pub/5612/ 1999-05-01T00:00:00Z OBJECTIVES: We sought to study the effect of early infusion of abciximab on coronary patency before primary angioplasty in patients with acute myocardial infarction. BACKGROUND: Glycoprotein IIb/IIIa antagonists have proved to be effective in reducing ischemic events associated with coronary angioplasty. The present study explores whether abciximab alone, without administration of thrombolytic therapy, may induce reperfusion in patients with acute myocardial infarction. METHODS: In the Glycoprotein Receptor Antagonist Patency Evaluation pilot study 60 patients with less than 6 h signs and symptoms of acute myocardial infarction eligible for primary angioplasty received in the emergency room a bolus of abciximab 250 microg/kg followed by a 12-h infusion of 10 microg/min. All patients were also treated with an oral dose of 160 mg aspirin and 5,000 IU of heparin intravenously. As soon as possible a diagnostic angiography was performed to evaluate the patency of the infarct-related artery. RESULTS: The median time between onset of symptoms and the administration of the abciximab bolus was 150 min (range 45 to 345), and the median time between abciximab bolus and first contrast injection in the infarct-related artery was 45 min (range 10 to 150). In 24 patients (40%, 95% confidence interval 28% to 52%) Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 was observed at a median time of 45 min (range 10 to 150) after abciximab bolus; TIMI flow grade 3 was observed in 11 patients (18%, 95% confidence interval 9% to 28%). There was no difference in percentage of TIMI flow grade 2 or 3 between patients who received abciximab within 2.5 h after onset of symptoms or thereafter. CONCLUSIONS: Abciximab therapy given in the emergency room in patients awaiting primary angioplasty is associated with full reperfusion (TIMI flow grade 3) in about 20% and with TIMI flow grade 2 or 3 in about 40% of the patients at a median time of 45 min. These figures are higher than those in primary angioplasty trials without such pretreatment. Randomized controlled trials of very early infusion of abciximab, either prehospital or in-hospital, in patients eligible for angioplasty are warranted. http://repub.eur.nl/res/pub/5523/ 1996-01-01T00:00:00Z The comparative efficacy of thrombolytic drugs and primary angioplasty for acute myocardial infarction have recently been studied, but long-term follow-up data have not yet been reported. We conducted a randomized trial involving 301 patients with acute myocardial infarction; 152 patients were randomized to primary angioplasty and 149 to intravenous streptokinase. Left ventricular function was assessed with a radionuclide technique both at hospital discharge and at the end of the follow-up period. Follow-up data were collected after a mean (+/-SD) of 31 +/- 9 months. Total medical costs were calculated. At the end of the follow-up period, 5% of the angioplasty patients had died from a cardiac cause compared to 11% of the patients randomized to intravenous streptokinase, P = 0.031. Cardiac death or a non-fatal reinfarction occurred in 7% of angioplasty patients compared to 28% of streptokinase patients, P < 0.001. There was a sustained benefit of angioplasty compared to streptokinase on left ventricular function. The total medical costs in the two groups were similar. Coronary anatomy (patency and single or multivessel disease), infarct location and previous myocardial infarction were important determinants of clinical outcome and costs. After 31 +/- 9 months of follow-up, primary angioplasty compared to intravenous streptokinase results in a lower rate of cardiac death and reinfarction, a better left ventricular ejection fraction, and no increase in total medical costs. http://repub.eur.nl/res/pub/4594/ 1994-01-01T00:00:00Z BACKGROUND: The objective of the study was to determine the coronary vasodilatory reserve in reperfused myocardium in patients with acute myocardial infarction and its relation to regional myocardial function. METHODS AND RESULTS: The study population consisted of 22 patients with acute myocardial infarction who underwent successful coronary angioplasty. The vasodilatory reserve in the reperfused myocardium was assessed quantitatively using computer-assisted digital subtraction cine-angiography immediately after angioplasty and at follow-up angiography before hospital discharge. Myocardial contrast medium appearance time and density were determined before and after pharmacological hyperemia induced by an intracoronary injection of 12.5 mg papaverine. Global and regional left ventricular functions were determined from contrast angiography. After papaverine, the mean contrast medium appearance time decreased significantly from 3.5 +/- 0.7 to 2.7 +/- 0.7 cardiac cycles (P < .000005) immediately after successful coronary angioplasty and from 3.8 +/- 0.7 to 2.7 +/- 0.9 cardiac cycles (P < .000005) at angiography before hospital discharge. The mean contrast medium density increased significantly from 48.7 +/- 13.8 to 61.0 +/- 19.0 pixels (P < .003) and from 49.6 +/- 19.7 to 80.3 +/- 29.6 pixels (P < .000005), respectively. As a consequence, the calculated coronary flow reserve increased significantly from 1.8 +/- 0.7 to 2.6 +/- 1.0 (P < .0008). The global ejection fraction increased significantly from 52 +/- 12% to 58 +/- 14% (P < .03), primarily because of a significant improvement in the regional myocardial function of the infarct zone from 20.8 +/- 9.0% to 26.0 +/- 10.5% (P < .001). Coronary flow reserve correlated well with regional myocardial function both during the acute phase (R = .79, P < .002) and at follow-up angiography (R = .82, P < .000004). Interestingly, coronary flow reserve measurement on reperfusion, immediately after angioplasty, correlated significantly with regional myocardial function at follow-up angiography (R = .81, P < .00003). CONCLUSIONS: The results indicate that there is a pharmacologically inducible vasodilatory reserve in reperfused ischemic myocardium after successful coronary angioplasty in patients with acute myocardial infarction and that this is increased at 10-day follow-up angiography. More important, the degree of reactive hyperemic response on reperfusion has a predictive value regarding the ultimate degree of recovery of regional myocardial function. Quantitative assessment of reperfusion may be useful in investigating the role of coronary reperfusion and salvage of myocardial function. http://repub.eur.nl/res/pub/4540/ 1993-01-01T00:00:00Z BACKGROUND. Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39 393, relative to unfractionated sodium heparin on periprocedural events, bleeding, early angiographic outcome, and coagulation in 113 patients with stable angina undergoing PTCA. METHODS AND RESULTS. Prior to PTCA, 20 mg CGP 39 393 was administered as a bolus, followed by continuous infusion at a rate of 0.16 mg.kg-1 x h-1, or 10,000 IU sodium heparin was administered as a bolus and continued at a rate of 12 IU.kg-1 x h-1 for 24 hours. Infusion was adjusted to activated partial thromboplastin time (APTT) levels. ST segment was monitored for 24 hours, and angiograms were analyzed with quantitative technique (QCA). In 74 CGP 39 393- and 39 heparin-treated patients, 132 lesions were dilated. Myocardial infarction and/or emergency coronary bypass surgery occurred in 1 (1.4%) CGP 39 393 patient compared with 4 (10.3%) heparin patients (relative risk, 7.6; 95% confidence interval, 0.9, 65.6). At 24 hours, complete perfusion was present in 91% heparin and 100% CGP 39 393 patients. Significant ST segment displacement was found in 11% of heparin versus 4% of CGP 39 393 subjects. Bleeding occurred only at the puncture site in 4 CGP 39 393-treated patients. QCA did not reveal significant differences between the groups. APTT values were more often in the target range and more stable in CGP 39 393 patients. Levels of thrombin-antithrombin III complexes, prothrombin fragment F1+2, and fibrinopeptide A indicated that CGP 39 393 was an effective inhibitor of thrombin activity. CONCLUSIONS. CGP 39 393 can safely be administered to patients undergoing elective PTCA for stable anginal symptoms and may have a more favorable anticoagulant profile than heparin. http://repub.eur.nl/res/pub/4545/ 1993-01-01T00:00:00Z Because of the unavoidable occurrence of vessel disruption after successful coronary balloon angioplasty, the reliability of quantitative angiographic analysis in that setting has been questioned. For this reason and the suggested occurrence of delayed elastic recoil, repeat angiography at 24 hours has been advocated in clinical interventional trials. In this study, these issues are confronted by performing comprehensive quantitative analysis (Cardiovascular Angiographic Analysis System) of coronary angiograms, acquired in multiple identical projections immediately after and 24 hours after angioplasty, in 102 patients with 110 successfully dilated lesions. Vasomotion was controlled by intracoronary nitrate before angiography and all patients were fully anticoagulated (activated partial thromboplastin time 85 to 120 seconds) for > 24 hours. Paired Student's t tests applied to angiographic measurements revealed that there was no significant deterioration in minimal luminal diameter or cross-sectional area from immediately after angioplasty to 24 hours later. It can thus be inferred that there is no phenomenon of delayed elastic recoil, at least during this time period. Measurement accuracy and precision of the Cardiovascular Angiographic Analysis System from the postangioplasty angiogram are highly acceptable, at < 0.01 and +/- 0.20 mm, respectively. Therefore, it is concluded that routine repeat 24-hour angiography is not indicated after successful angioplasty. A highly significant increase (p < 0.001) in reference diameter (+0.11 +/- 0.18 mm) was responsible for the apparent increase in percent diameter stenosis (2.4 +/- 7%), a finding that demonstrates the potential for error by selective application of percent diameter stenosis measurements alone. Preferential use of absolute luminal measurements is thus strongly recommended for clinical trials with angiographic monitoring. http://repub.eur.nl/res/pub/4331/ 1989-01-01T00:00:00Z Intracoronary blood flow velocity measurements with a Doppler balloon catheter and the radiographic assessment of myocardial perfusion with contrast media, before and after the intracoronary administration of papaverine, have previously been used to investigate regional coronary flow reserve. In the present study we applied both techniques in 21 patients to measure coronary flow reserve in the setting of coronary angioplasty. Pre-angioplasty (N = 14) and post-angioplasty (N = 19) measurements of coronary flow reserve were obtained by digital subtraction cineangiography in the myocardial region supplied by the dilated coronary artery, and with the Doppler probe in the proximal part of the dilated vessel. The reactive hyperaemia following the final balloon inflation was recorded with the Doppler balloon catheter still positioned across the stenotic lesion. Coronary stenosis geometry was quantified with the Cardiovascular Angiography Analysis System. When the epicardial stenosis was the only factor causing a reduction in coronary flow reserve, flow reserve measured with both digital subtraction cineangiography and with the Doppler probe correlated well with the cross-sectional area at the site of obstruction, r = 0.88, SEE = 0.36 and r = 0.77, SEE = 0.45 respectively. In contrast, when other factors decreasing coronary flow reserve were present (intimal dissection, left ventricular hypertrophy, previous myocardial infarction, collaterals) measurements obtained with both techniques correlated poorly with cross-sectional area (r = 0.55, SEE = 0.57, and r = 0.59, SEE = 0.50). Flow reserve measurements obtained with digital subtraction cineangiography correlated well with the measurements obtained with the Doppler probe (r = 0.85, SEE = 0.38, and r = 0.87, SEE = 0.34), although the two approaches have methodologically nothing in common and their respective regions of interest (myocardium for the radiographic technique and intracoronary lumen for the Doppler technique) are basically different. Furthermore, the reactive hyperaemia following the final balloon inflation was related to the flow reserve measured with both the angiographic technique (r = 0.85, SEE = 0.34) and the Doppler technique (r = 0.83, SEE = 0.32) using pharmacologically induced coronary vasodilation with intracoronary papaverine. This suggests that the same quantity of coronary flow reserve that can be recruited pharmacologically can be recruited by ischaemia following a transluminal occlusion. http://repub.eur.nl/res/pub/4333/ 1989-01-01T00:00:00Z In a 61-year-old patient with unstable angina an attempt was made to dilate a severe stenosis in a tortuous obtuse marginal branch. The initial attempt with conventional equipment was not successful; although the wire could be advanced distal to the stenosis, a 2.0 balloon did not cross the stenosis. A second attempt with a balloon on a wire device resulted in fracture of this catheter, with the distal 2.8-cm-long fragment looped in the left coronary artery. Immediate bypass surgery was performed and the broken fragment was easily removed from the left coronary ostium. The patient made an uneventful recovery. http://repub.eur.nl/res/pub/4264/ 1988-01-01T00:00:00Z Intracoronary papaverine is used as a means to induce a strong and short-lasting hyperemia in several recently developed methods to measure coronary flow reserve. Changes in stenosis geometry from papaverine would influence the measured coronary flow reserve. Therefore, we investigated the influence of intracoronary papaverine on stenosis geometry with quantitative analysis of the coronary angiogram and assessed the influence of papaverine on pressure-flow characteristics of the stenosis and coronary flow reserve. The cross-sectional areas (mean +/- SD) of the stenosis increased 18% +/- 7% after papaverine. The normal proximal and distal parts of the coronary artery dilated 5% +/- 2% after papaverine. This results in a decrease of the calculated pressure drop over the stenosis varying from 20% to 30%. Coronary flow reserve of a flow-limiting epicardial stenosis is overestimated by 16% when papaverine is used to induce hyperemia. These papaverine-induced changes can nevertheless be circumvented by maximal vasodilation of the major epicardial coronary artery with 3 mg intracoronary isosorbidedinitrate prior to the investigation of the coronary flow reserve with papaverine. http://repub.eur.nl/res/pub/4266/ 1988-01-01T00:00:00Z Fifteen patients undergoing routine follow-up angiography 5 months after successful percutaneous transluminal coronary angioplasty (PTCA) without angina and with normal exercise thallium scintigraphy were selected for analysis. The coronary flow reserves of these patients were compared with those of 24 patients with angiographically normal coronary arteries to establish whether PTCA can restore to normal the coronary flow reserve of patients with chronic coronary artery disease. The quantitative cineangiographic changes and the concomitant alterations in coronary flow reserve as an immediate result of the PTCA and the subsequent changes 5 months later are described. Coronary flow reserve was measured with digital subtraction cineangiography. PTCA resulted in an increase in minimal obstruction area (mean +/- standard deviation) from 0.8 +/- 0.3 to 3.4 +/- 0.7 mm2 and in coronary flow reserve from 1.0 +/- 0.3 to 2.5 +/- 0.6. Five months later a further substantial and significant (p less than 0.05) late increase in obstruction area (3.8 +/- 0.9 mm2) and flow reserve (3.6 +/- 0.5) had occurred. In 11 of 15 patients coronary flow reserve was restored to normal. Changes in stenosis geometry are likely to be 1 of the major determinants of this late normalization of coronary flow reserve. http://repub.eur.nl/res/pub/4275/ 1988-01-01T00:00:00Z Despite initially favorable prognosis in patients with non-Q-wave acute myocardial infarction (AMI), long-term mortality in this subset of patients appears to be similar to or even greater than that in patients with Q-wave AMI. The relatively poor late prognosis is primarily due to a high incidence of unstable angina and recurrent AMI. Between January 1982 and January 1987, 114 patients with suitable coronary narrowing underwent percutaneous transluminal coronary angioplasty (PTCA) for angina pectoris (present either at rest or during mild exertion, and despite optimal pharmacologic therapy), a median of 31 (range 2 to 362) days after a non-Q-wave AMI. Success was achieved in dilating the obstructed artery in 98 patients (113 of the 129 dilated arteries). Emergency bypass surgery was performed in 7 patients. Mean clinical follow-up of 20 (range 3 to 59) months was obtained in all patients and revealed no deaths. Of the 98 patients with successful PTCAs, 6 (6%) developed a nonfatal recurrent AMI and 62 (63%) were asymptomatic. However, recurrent angina affected 31 patients (32%) and was treated by repeat PTCA (n = 18), coronary bypass surgery (n = 5) or pharmacologic therapy (n = 8). At follow-up, 74% of the patients (73 of 98) were asymptomatic after a successful PTCA and, if necessary, a repeat PTCA, without incidence of recurrent AMI, coronary bypass surgery or death. The high initial success rate, low incidence of subsequent death and late recurrent AMI and sustained symptomatic benefit suggest that PTCA is an effective initial treatment strategy in these selected patients. http://repub.eur.nl/res/pub/4276/ 1988-01-01T00:00:00Z To investigate the clinical usefulness of intracoronary Doppler recordings during percutaneous transluminal coronary angioplasty (PTCA), the changes of intracoronary blood flow velocity during PTCA were assessed in 20 patients with single proximal coronary stenosis, using a Doppler probe end-mounted on the tip of a PTCA catheter. A mean of 4 inflations was performed in each patient. Intracoronary velocities were measured before and after each inflation and during peak reactive hyperemia after each transluminal occlusion. Quantitative analysis of the coronary stenosis was assessed before and after PTCA, and the dilatation resulted in an increase in minimal luminal cross-sectional area from 1.1 +/- 0.8 to 2.7 +/- 1.2 mm2. A gradual and significant improvement in velocities was observed after the first 3 dilatations, but in 15 of the 20 patients the resting and hyperemic velocities were not affected by the fourth dilatation. Coronary flow reserve measured during reactive hyperemia after the last dilatation with the PTCA catheter across the lesion was 1.9. This value of coronary flow reserve is compatible with the residual stenosis measured after PTCA when corrected for the presence of the Doppler balloon catheter (0.68 mm2). This application of the Doppler technique may provide a new method of on-line functional monitoring of the PTCA procedure in individual patients, but does not yet allow an accurate prediction of the change in coronary geometry brought about by PTCA. http://repub.eur.nl/res/pub/4296/ 1988-01-01T00:00:00Z The assessment of coronary flow reserve from the instantaneous distribution of the contrast agent within the coronary vessels and myocardial muscle at the control state and at maximal flow has been limited by the superimposition of myocardial regions of interest in the two-dimensional images. To overcome these limitations, we are in the process of developing a three-dimensional (3D) reconstruction technique to compute the contrast distribution in cross sections of the myocardial muscle from two orthogonal cineangiograms. To limit the number of feasible solutions in the 3D-reconstruction space, the 3D-geometry of the endo- and epicardial boundaries of the myocardium must be determined. For the geometric reconstruction of the epicardium, the centerlines of the left coronary arterial tree are manually or automatically traced in the biplane views. Next, the bifurcations are detected automatically and matched in these two views, allowing a 3D-representation of the coronary tree. Finally, the circumference of the left ventricular myocardium in a selected cross section can be computed from the intersection points of this cross section with the 3D coronary tree using B-splines. For the geometric reconstruction of the left ventricular cavity, we envision to apply the elliptical approximation technique using the LV boundaries defined in the two orthogonal views, or by applying more complex 3D-reconstruction techniques including densitometry. The actual 3D-reconstruction of the contrast distribution in the myocardium is based on a linear programming technique (Transportation model) using cost coefficient matrices. Such a cost coefficient matrix must contain a maximum amount of a priori information, provided by a computer generated model and updated with actual data from the angiographic views. We have only begun to solve this complex problem. However, based on our first experimental results we expect that the linear programming approach with advanced cost coefficient matrices and computed model will lead to acceptable solutions in the 3D-reconstruction of the myocardial contrast distribution from biplane cineangiograms. http://repub.eur.nl/res/pub/4298/ 1988-01-01T00:00:00Z The goal of this investigation was to establish which measured anatomic variable of stenotic coronary lesions correlates best with functional severity. Therefore, 38 patients with single vessel disease underwent coronary cineangiography and exercise/redistribution thallium-201 scintigraphy. The computer-based Cardiovascular Angiography Analysis System was used to determine the cross-sectional area at the site of obstruction (OA) and percent diameter stenosis (DS), and to calculate the pressure drop over the stenosis (PD) with use of fluid dynamic equations. Coronary flow reserve was measured radiographically. Myocardial perfusion defects on thallium scintigrams were analyzed quantitatively and by visual interpretation. The relations between coronary flow reserve (CFR) and the three anatomic variables were described by the following equations: 1) CFR = 4.6 - 0.053 DS, r = 0.82; SEE: 0.79, p less than 0.001. 2) CFR = 0.5 + 0.75 OA, r = 0.87; SEE: 0.68, p less than 0.001). 3 CFR = 3.6 - 1.5 log PD, r = 0.90; SEE: 0.62, p less than 0.001. The calculated pressure drop was highly predictive of the thallium scintigraphic results with a sensitivity of 94% and a specificity of 90%. The calculated pressure drop is a better anatomic variable for assessing the functional importance of a stenosis than is percent diameter stenosis or obstruction area. However, the 95% confidence limits of the relation between pressure drop and coronary flow reserve are wide, making the measurement of coronary flow reserve an indispensable addition to quantitative angiography, especially when determining the functional importance of moderately severe coronary artery lesions. http://repub.eur.nl/res/pub/4299/ 1988-01-01T00:00:00Z Assessment of the functional significance of coronary artery lesions during cardiac catheterization has recently become possible by calculating coronary flow reserve from both myocardial contrast appearance time and density in the resting and hyperemic states determined from digitized coronary cineangiograms. However, the interobserver and intraobserver variabilities, as well as the short-, medium-, and long-term variabilities of the coronary flow reserve measurements, have to be established before this technique becomes an acceptable means of assessing the immediate and long-term functional results of revascularization procedures such as percutaneous transluminal coronary angioplasty (PTCA). Variability was defined as the mean difference and standard deviation of the difference between duplicate determinations of coronary flow reserve. The intraobserver variability (mean difference +/- SD) in the measurement of coronary flow reserve was -0.01 +/- 0.07. Interobserver variability by two observers was +0.08 +/- 0.52. Short-term variability based on the analysis of two coronary cineangiograms taken 5 minutes apart was -0.02 +/- 0.26. Medium-term variability (coronary cineangiographies repeated 1-3 hours apart) was found to be -0.06 +/- 0.52. Long-term variability (coronary cineangiographies repeated 3-5 months apart) was 0.11 +/- 0.63. Having established the reproducibility of this radiographic method, we studied the prospective changes in coronary flow reserve in 25 patients undergoing PTCA for single vessel coronary artery disease. Coronary flow reserve measurements and quantitative coronary cineangiography were performed before, immediately after, and 3-5 months after PTCA. PTCA resulted in an immediate increase in coronary flow reserve from 1 +/- 0.3 to 2.3 +/- 0.6 with a concomitant increase in obstruction area from 0.9 +/- 0.3 to 3.3 +/- 0.7 mm2. Nine of the 25 patients developed restenosis defined as a diameter stenosis greater than 50% at follow-up. The other 16 patients had a coronary flow reserve of 3.3 +/- 0.6, which was measured 3-5 months after PTCA. Coronary flow reserve measurement from digitized coronary cineangiograms is a reproducible method for the assessment of the physiological importance of coronary artery obstructions. Short-, medium-, and long-term investigations of the functional results of interventions such as pharmacological therapy or revascularization can be performed reliably with this technique. http://repub.eur.nl/res/pub/4250/ 1987-01-01T00:00:00Z To study the relationship between the quantitatively assessed coronary artery dimensions and the regional coronary flow reserve as measured by digital subtraction cineangiography, we investigated 17 coronary arteries with a single discrete proximal stenosis and 12 normal coronary arteries before and after intracoronary administration of papaverine. Coronary flow reserve was found to be curvilinearly related to minimal luminal cross-sectional area (r = .92, SEE = 0.73) and to percentage area stenosis (r = .92, SEE = 0.74). Normal coronary arteries had a coronary flow reserve of 5.0 (+/- 0.8 [SD]), which differed significantly from the coronary flow reserve of the coronary arteries with obstructive disease, in which values ranging from 0.5 to 3.9 were found. Coronary arteries with a percentage area stenosis between 50% and 70% and a minimal luminal cross-sectional area between 2 and 4.5 mm2 differed significantly (p = .001), with respect to the coronary flow reserve, from coronary arteries with a percentage area stenosis in excess of 70% and a minimal luminal cross-sectional area less than 2 mm2. With the use of hemodynamic equations that describe the pressure loss over a stenosis, a theoretical pressure-flow relationship can be inferred that characterizes the severity of the stenosis. Based on this theoretical pressure-flow relationship, coronary arteries that have a limited coronary flow reserve and critical stenosis (distal coronary perfusion pressure below 40 mm Hg at coronary flow of 3 ml/sec) can be identified with high sensitivity (83%) and specificity (82%). Thus, in coronary artery disease the consequent reduction in coronary flow reserve can be predicted with reasonable accuracy by quantitative assessment of coronary artery dimensions. http://repub.eur.nl/res/pub/4257/ 1987-01-01T00:00:00Z http://repub.eur.nl/res/pub/4206/ 1986-01-01T00:00:00Z A potent, short-acting vasodilator that induces a maximal hyperemic response of the coronary vascular bed is needed to determine coronary flow reserve. In 12 patients, we measured coronary sinus blood flow by thermodilution over a period of 2 min during which a bolus of 10 mg papaverine was given into the left main coronary artery. This was repeated after 5 min to assess the reproducibility of the changes. The maximal hyperemic response lasted from 24 until 37 sec after papaverine administration. There was no significant difference between the two consecutive hyperemic responses (Student's t-test for paired observations). The mean difference between first and second hyperemic responses at 30 sec was 7.0% (SD +/- 6.2%). In conclusion, 10 mg of intracoronary papaverine is a short-lasting and reproducible means of inducing a maximal hyperemic response in the coronary vascular bed and therefore appears to be the ideal agent for investigating coronary flow reserve. http://repub.eur.nl/res/pub/5340/ 1986-01-01T00:00:00Z