Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis?

Abstract

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.