Comparison of relative coronary Doppler flow velocity reserve to stress myocardial perfusion imaging in patients with coronary artery disease

To compare relative coronary artery vasodilator reserve (rCVR = CVRtarget/C VRreference) to myocardial perfusion stress imaging, 48 patients with coron ary artery stenoses (61% +/- 16%; mean, +/- SD; range, 30%-91%) had measure ments of target and reference vessel CVR (Doppler-tipped guidewire). rCVR w as computed and compared to stress (201)thallium or (99m)technetium-sestami bi myocardial tomography. Compared to 24 patients with negative stress imag ing studies, 24 patients with positive stress studies had angiographically more severe stenoses (74% +/- 13% vs. 44% +/- 24%; P = 0.0005) with lower C VR,,,,,, (1.68 +/- 0.55 vs. 2.46 +/- 0.74; P = 0.002) and lower rCVR (0.72 +/- 0.22 vs. 1.0 +/- 0.26; P < 0.003). Based on receiver-operator character istic (ROC) cut points (CVR > 1.9; rCVR > 0.75), compared to CVR, rCVR had similar agreement (Kappa 0.54 vs. 0.50), sensitivity (63% vs. 71%), specifi city (88% vs. 83%), and positive predictive value (83% vs. 81%) with myocar dial perfusion tomography. A concordant CVRtarget/rCVR only slightly increa sed sensitivity, specificity, and positive predictive values (77%, 90%, and 87%, respectively). Although rCVR, like CVR, correlates with stress myocar dial perfusion imaging results, rCVR did not have significant incremental p rognostic Value over CVR alone for myocardial perfusion imaging. However, r CVR does provide additional information regarding the status of the microci rculation in patients with coronary artery disease and complements the CVR for lesion assessment. (C) 2001 Wiley-Liss, Inc.