Background: Transthoracic Doppler echocardiography is a valuable tool to measure coronary flow reserve (CFR) and detect in-stent restenosis (ISR) after percutaneous coronary angioplasty in selected series of patients. OBJECTIVES: To assess the usefulness of coronary flow reserve measured by echocardiography in detecting significant (> 70%) ISR of the left anterior descending coronary artery in a large unselected population. Methods: Two hundred and twenty-three patients (age 61 ± 10 years; 168 men) treated with left anterior descending stenting underwent CFR measurement by transthoracic Doppler echocardiography and venous adenosine infusion 24-72 h before control coronary angiography. Coronary-active drugs were continued, and patients with multiple risk factors and old anterior-apical myocardial infarction were included. Results: Significant ISR occurred in 56 patients (25%). Patients with ISR had higher basal coronary flow velocity (27 ± 10 cm/s vs. 24 ± 7 cm/s; P < 0.002) and lower CFR (1.5 ± 0.5 vs. 2.7 ± 0.6; P < 0.0001) than those without ISR. A linear relation was found between ISR and CFR (r =-0.73; P < 0.0001) and remained significant after adjustment for blood pressure and heart rate (r =-0.74; P < 0.0001). A CFR less than two identified significant ISR (sensitivity 88%, specificity 88%, area under the curve = 0.943; P < 0.001). In a multivariate model of CFR prediction, myocardial infarction and heart rate were slightly contributory (ß =-0.19, P < 0.01; ß =-0.16, P < 0.03, respectively), whereas ISR had a large influence (ß =-0.66; P < 0.0001). The inverse correlation between ISR and CFR persisted in patients with myocardial infarction (r =-0.64; P < 0.0001) and in those treated with β-blockers (r =-0. 71; P < 0.0001). Conclusion: Echocardiographic measurement of CFR detects significant left anterior descending ISR in unselected patients with multiple risk factors, old anterior-apical myocardial infarction, and taking β-blockers.
- Coronary angioplasty
- Coronary artery disease
- Coronary flow reserve
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine