Feasibility of the PCI through 6F diagnostic catheters.

BACKGROUND: The choice of guiding catheter for optimal back-up support is critical in order to achieve a successful PCI. Diagnostic 6 French (F) catheters have an internal lumen diameter as large as 5F guiding catheters. The aim of this study was to demonstrate for the first time the feasibility of performing PCI with Cordis 6F diagnostic catheters in selected coronary lesions. METHODS: 32 coronary stents were implanted using 6F diagnostic catheters in 27 eligible patients at the Montreal Heart Institute. The inclusion criteria were TIMI angiographic score < B2 in native coronary arteries or in coronary artery bypass grafts. Bifurcations and left main disease were not included. RESULTS: Eighty-five percent of the patients underwent PCI for acute coronary syndromes (ACS). PCI was performed in 5 lesions (19%) of the left coronary circulation; in 21 lesions (78%) of the right coronary artery and in one lesion (4%) of the 1st obtuse marginal branch of the circumflex artery, through a left mammary artery bypass. Only stents suitable for 5F guiding catheters were used. The largest stent was 4.0 mm in diameter and 32 mm in length. Direct stenting was performed in 75% of patients. The angiographic success for PCI of target lesions was 100%, without clinical or angiographic complications. CONCLUSIONS: In selected cases, diagnostic 6F catheters can be used for PCI with 5F compatible balloons and stents. PCI via a diagnostic catheter may provide even better back-up support and allows for significant resources and time savings, especially in patients with ACS.     

Accuracy and reproducibility of quantitative coronary arteriography using 6 and 8 French catheters with cine angiographic acquisition

To determine the suitability of 6 French catheters for quantitative coronary arteriography, the relative accuracy and reproducibility of one type of these catheters was compared to that obtained with standard 8 French catheters in 20 stenoses. Duplicate injections with polyurethane 6 French catheters were obtained using hand and power injection technique with cineangiographic acquisition (four 6 French catheter injections total per stenosis). Measurements of both percent diameter stenosis and absolute dimensions were compared to those obtained with hand injection and cine acquisition using 8 French catheters as a "gold standard." While the reproducibility of dimension determination with the 6 French catheter was generally similar to that obtained with the 8 French catheter (0.27 +/- 0.23 mm for absolute diameter and 8.1 +/- 7.4% for percent diameter stenosis), accuracy was significantly less for the 6 French catheter for measurement of absolute dimensions. Thus, while apparently well suited for serial measurements of the same stenoses, 6 French catheters may not be as accurate in the determination of absolute artery dimensions as 8 French catheters.     

Validation of 4 French catheters for quantitative coronary analysis: in vivo variability assessment using 6 French guiding catheters as reference scaling devices

Although numerous studies have established the utility of 4 F catheters for routine coronary angiography, its adequacy for automatic quantitative coronary analysis has not been previously assessed. METHODS: In 32 consecutive patients, coronary angiography was performed sequentially with 4 F diagnostic catheters and 6 F guiding catheters after intracoronary nitroglycerin. A total of 43 lesions were evaluated for quantitative analysis using both types of catheter as scaling devices. Possible differences in the reference diameter, minimal luminal diameter and percent diameter stenosis were evaluated. All measurements were performed offline by the same operator and intraobserver variability estimation was performed by repeating the evaluation in 12 lesions randomly selected after 1 month. RESULTS: The mean reference diameter was 2.98+/-0.48 mm, mean minimal luminal diameter was 1.00+/-0.52 mm and percent diameter stenosis was 67.1+/-15.3%. Accuracy (mean difference of values) was 0.009 mm for reference diameter, 0.005 mm for minimal luminal diameter and 0.25% for percent diameter stenosis. Precision (mean standard deviation of the differences) was 0.17 mm for reference diameter, 0.19 mm for minimal luminal diameter and 5.93% for percent stenosis. Linear correlation for these three variables was 0.94, 0.93 and 0.93, respectively. Intraobserver variability analysis showed similar values for accuracy, precision and linear correlation. CONCLUSIONS: Angiography with 4 F catheters allows adequate quantification of luminal diameters as compared to most accepted clinical standards. These results may have implications for the selection of diagnostic catheters for routine follow-up assessment of percutaneous coronary interventions.     

Randomized comparison of coronary angiography using 4F catheters: 4F manual versus "Acisted" power injection technique.

Compared with 6F catheters, diagnostic coronary angiographic and ventriculographic images with 4F catheters can be obtained with equivalent results using less radiographic contrast volume. Whether 4F coronary angiography would be superior using a power-assisted, operator-controlled technique compared with manual technique is unknown. To determine whether 4F coronary angiography using operator-controlled power injection (Acist, Minneapolis, MN) was equivalent or superior to the 4F manual technique, 96 unselected patients undergoing transfemoral coronary angiography were randomized to 4F catheter using a power injection or manual technique. Procedural characteristics and angiographic quality scores were analyzed. Comparing the 4F manual with the 4F power-injection technique, coronary angiographic quality scores were equivalent (left coronary artery 4.7 +/- 0.5 vs. 4.7 +/- 0.6, P = 0.99; right coronary artery 4.94 +/- 0.2 vs. 4.88 +/- 0.1, P = 0.21). Left ventriculography scores were lower in 4F Acist with similar contrast volumes. The total study contrast volume was significantly less in the 4F Acist group (119 +/- 35 vs. 149 +/- 49 ml, P = 0.001). Compared with the 4F manual contrast injection technique, diagnostic angiography through 4F catheters with power contrast injection resulted in equivalent coronary angiographic image quality with significantly less radiographic contrast volume.     

Coronary angiography with 4 f catheters by the radial: minimally invasive catheterization

INTRODUCTION AND OBJECTIVES: Experience with 4 F catheters in cardiac catheterization is limited. These devices appear to be more suitable for the radial artery approach than conventional 6 F catheters. METHODS: We analyze our preliminary experience with diagnostic catheterization of the radial artery with 4 F catheters. Angiographic images were evaluated using a predefined scale (1. poor; 2. acceptable; 3. optimal). In a subgroup of patients who underwent coronary angioplasty, the quantitative angiographic data obtained with the 4 F catheter were compared to those obtained with the 6 F guide catheter. In all cases the patients were clinically followed-up at 24 h and 7 days. RESULTS: Two hundred and six studies performed over a 12-month period were reviewed. In 6 cases (2.9%) the femoral vein had to be used instead and in 4 cases (1.9%) the 4 F catheters were replaced by 6 F catheters. The left coronary angiography was graded as optimal in 83% and as acceptable in 15%. Right coronary artery images were considered optimal in 93% and acceptable in 7%. There was an excellent correlation between the reference diameter obtained by quantitative angiography with the 4 F catheter and values obtained with a 6 F guide catheter (r = 0.92; p < 0.01). No major vascular complications occurred. CONCLUSION: 4 F catheters are appropriate for systematic use in diagnostic procedures using the radial access.     

Multicentre, prospective, randomized trial of 4 vs. 6 French catheters in 410 patients undergoing coronary angiography.

The aim of this study was to assess the quality of angiograms obtained using 4 Fr catheters compared with 6 Fr catheters, the ease of use of the 4 Fr catheters, and the safety of patient mobilization 1 hr following 4 Fr angiography. Details of catheter performance and procedural details were recorded at the time of the angiogram. The angiographic images were scored on the quality and completeness of vessel opacification throughout systole and diastole. A total of 410 patients were recruited. There was no difference between 4 and 6 Fr for procedural variables. All angiograms were considered to be of diagnostic quality. The angiographic scores for the right coronary artery and left ventricular injections were no different between 4 and 6 Fr. However, the angiographic scores for the left anterior descending and circumflex arteries were lower with 4 than with 6 Fr (both P < 0.05). Patients who had 4 Fr angiography mobilized safely at 1 hr and reported significantly less discomfort and bruising than 6 Fr patients. Good-quality diagnostic coronary angiograms can be achieved using 4 Fr catheters with the advantage of earlier postprocedural mobilization and reduced discomfort and bruising for the patient.     

A prospective randomized study of 4.1 French catheters utilizing the percutaneous right brachial approach for the diagnosis of coronary artery disease

To determine the utility of 4.1 French (F) catheters in diagnosing coronary artery disease, 50 patients were randomized to 4.1F Multipurpose or Judkins catheters utilizing the percutaneous right brachial approach. The randomized 4.1F tip shape catheter completed the procedure in 40% of the patients, and overall the 4.1F catheters completed the catheterization in 72% of the cases. With excessive or prolonged manipulation, the catheters were noted to kink and soften and required replacement for a catheter of similar or larger size. In 28% of the cases, larger F sizes (5F and 6F) were used to complete the procedure. There was 1 (2%) procedural complication. The total procedural success (accounting for all F sizes) without clinical complication was 98%. There was no difference between the 4.1F Judkins or Multipurpose catheter shapes for coronary arteriography by either qualitative or quantitative angiographic analysis. Left ventricular opacification was improved with the 4.1F Pigtail vs. the 4.1 Multipurpose by qualitative angiographic analysis. When the 4.1F angiograms were compared by quantitative angiography in blinded, but not randomized fashion to angiograms performed with 6F Judkins catheters, there was improved opacification of the LAD and diastolic frame of the left ventriculogram with the larger catheter. This difference was not noted with qualitative angiography. This study indicates that 4.1F catheters can be utilized from the right brachial approach for the diagnosis of coronary artery disease, thus avoiding the need for supine bedrest associated with routine femoral artery catheterization while maintaining diagnostic accuracy. © 1992 Wiley-Liss, Inc.     

Agreement between coronary flow velocity reserve and stress echocardiography in intermediate-severity coronary stenoses.

Visual and quantitative assessments of percent diameter stenosis on coronary angiography correlate poorly with functional testing, particularly in intermediate-severity (40%-70%) lesions, yet are frequently relied on to make decisions regarding revascularization. Coronary flow velocity reserve (CFVR) and relative CFVR (RCFVR) are promising methods for on-line functional assessment of lesion severity in the catheterization laboratory. We sought to determine the agreement between maximal, mean, and relative CFVR and stress echocardiography in intermediate-severity stenoses. The results of exercise or dobutamine stress echocardiography and CFVR measured by intracoronary Doppler were compared in 28 patients referred for assessment of intermediate-severity stenoses, using 15 patients with either angiographically normal coronary arteries or diameter stenoses > 70% as reference groups. CFVR was measured at least three times in response to a bolus of adenosine in the target vessel distal to the stenosis. RCFVR (target/normal vessel CFVR) was also measured in 27 patients. Maximal, mean (of three measures), and relative CFVR were calculated. CFVR > or = 2.0 and RCFVR > or = 0.75 were accepted as normal. A minority (29%) of patients in the intermediate-severity stenosis group had a positive test by either method. There was good to very good agreement between stress echocardiography and maximal CFVR (84%, kappa = 0.62, P < 0.0001) and RCFVR (81%, kappa = 0.59, P < 0.001) across the entire patient cohort, though in the intermediate subgroup concordance was only fair. Using the mean (of three measures of) CFVR for the same comparison improved the agreement in the intermediate subgroup to good (86%, kappa = 0.58, P = 0.002), and in the entire cohort the agreement was very good (88%, kappa = 0.74, P < 0.0001). There was only fair correlation between measures of CFVR and percent coronary stenosis. CFVR improved from 1.8 +/- 0.8 to 2.7 +/- 0.7 after percutaneous intervention (n = 12, P < 0.0001). These results suggest that there is good agreement between CFVR and stress echocardiography across a wide range of coronary lesion severity. The mean of three CFVR measurements distal to the target vessel stenosis increases diagnostic accuracy. Intracoronary Doppler flow velocity measurements at the time of cardiac catheterization may facilitate improved decision-making by providing the ability to assess the functional significance of coronary stenoses on-line.     

Accuracy of individual and panel visual interpretations of coronary arteriograms: implications for clinical decisions

The visual interpretation of coronary arteriograms by individuals has been shown to be variable and inaccurate. To determine whether observer accuracy improves with experience or with use of the mean values obtained from a panel of observers, the visual readings of percent diameter stenosis and "normal" reference segment diameter were compared with the quantitative analyses of 13 randomly chosen coronary stenoses. Visual interpretation was also performed on cineangiograms of seven phantom stenoses ranging in severity from 17% to 83%. Repeated quantitative arteriography demonstrated good intraobserver variability for minimal stenosis diameter (r = 0.91, SD = 0.23 mm) and percent diameter stenosis (r = 0.93, SD = 6.4%). When the mean of the repeated quantitative analyses was used as the standard, visual interpretations of percent diameter stenosis were found to have considerable inaccuracy (r = 0.78, SD = 14.5%). Phantom percent diameter stenosis data were better correlated (r = 0.85), but accuracy remained poor (SD = 17.8%). Fifty percent narrowings were read over a range from 30% to 95%. Substantial inaccuracies were also found for observer assessment of normal reference segment diameter (r = 0.75, SD = 0.75 mm). Observer accuracy of percent stenosis did not correlate with prior angiographic experience but was progressively improved by taking the mean value of the interpretations of three and five experienced angiographers (r = 0.88, 0.89; SD = 11.3%, 8.3%, respectively). These findings suggest that arteriographic interpretations accurate enough for interventional decisions can only be obtained using quantitative arteriography or the mean value of data from a large panel of angiographers.     

Improved stability and visualization during coronary artery angioplasty using a double catheter technique

Guiding catheters used in coronary angioplasty can make coronary angioplasty potentially hazardous when they become positionally unstable, induce myocardial ischemia, or impair angiographic visualization. In order to avoid this problem, a double catheter technique was employed in seven patients involving nine procedures consisting of a standard 8 or 9 French angioplasty guiding catheter and a standard 7 French angiographic catheter to prevent coronary flow reduction and to permit improved coronary artery visualization. In two of the procedures, the second diagnostic catheter also permitted the prevention of potential plaque disruption by the guide catheter in the proximal right coronary artery. The predilatation stenosis was 88 +/- 12%; the postdilatation stenosis was 28 +/- 9%. The use of the diagnostic catheter as a second catheter prevented damping and permitted the stable disengagement of the guiding catheter from the coronary artery. This technique is most useful in patients who have proximal right coronary artery stenoses because it provides optimal visualization of the segment undergoing dilatation, avoids the potential for ischemia in more distal stenoses, and thereby allows the procedure to be performed in a controlled, unhurried manner.     

Pitfalls in the determination of absolute dimensions using angiographic catheters as calibration devices in quantitative angiography

Using catheter outer diameter as a scaling device, quantitative coronary arteriography allows the precise and objective measurement of change in absolute dimensions of coronary arteries after mechanical or pharmacologic intervention. Because of variable density in the wall of the catheter, automated systems might vary in the determination of the outer catheter diameter. To examine this premise, catheters in a variety of French sizes from 6 manufacturers were injected with radiographic contrast and used as scaling devices for arterial phantoms of known geometric dimension. Radiographic diameters of the catheters were determined by applying the quantitative coronary arteriographic algorithm to the catheters using a calibration grid in the same field of view. The varying composition of the catheters resulted in differing x-ray attenuation and, subsequently, automated edge-detection algorithms varied widely in determining the actual catheter diameter to be used as a scaling factor. For instance, a Lucite "artery" with a minimal luminal diameter of 1.50 mm (image calibrated using the micrometer-determined outside diameter of a Baxter 8Fr guiding catheter) resulted in a quantitative angiographic diameter of 2.03 mm (overestimation by 35%). If the diameter of a similar size Shiley catheter was used to calibrate the image, a luminal diameter of 1.60 mm was determined: a difference of 0.43 mm based solely on differences in scaling catheter attenuation. These data suggest that a specific "fingerprint" for each catheter material and catheter French size exists, rendering generalizations about catheter size questionable. These observations are important for quantitative angiography where many brands and sizes of angiographic catheters are being used clinically.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intra- and interobserver variability of a fast on-line quantitative coronary angiographic system

To evaluate intra- and interobserver variability of an on-line quantitative coronary angiographic system, 2 independent observers measured 166 primary lesions excluding total occlusions before and after coronary angioplasty. Each observer repeated his measurement 3 times at 14 days interval. The average percent diameter stenosis results obtained by observer 1 and 2 were almost identical, before (62.2% ± 12.0% and 62.6% ±11.4%, NS) and after (27.1% ± 12.0% and 26.9% ± 11.3%, NS) angioplasty.Variability was expressed as 95 % limits of agreement (mean difference ± 2 x SD). The intra-observer variability of observer 1 ranged from – 6.6% to 6.6% before angioplasty and from – 9.6% to 9.6% after angioplasty. The corresponding limits of observer 2 were – 8.0% to 7.5% and – 8.3% to 8.5%, respectively. The interobserver variability ranged from –10.4% to 9.6% before versus –12.5% to 13.1% after angioplasty. This variability was not influenced by vessel size. The widening of the limits observed after angioplasty was largely due to an increased variability in the measurements of the absolute minimal luminal diameter but not of the reference segment. We conclude that the intra- and interobserver variability of measurements obtained with an on-line quantitative angiographic system used for guiding coronary interventions is acceptable and without systematic bias in any direction for a wide range of primary coronary stenoses. However, the variability increases when images are acquired immediately after angioplasty.Abbreviations PTCA percutaneous transluminal coronary angioplasty - QCA quantitative coronary arteriography     

Angiography-derived functional assessment of left main coronary stenoses

Objectives

We aimed to evaluate the diagnostic accuracy of quantitative flow ratio (QFR) in left main (LM) coronary stenoses, using Fractional Flow Reserve (FFR) as reference.

Background

QFR has demonstrated a high accuracy in determining the functional relevance of coronary stenoses in non-LM. However, there is an important paucity of data regarding its diagnostic value in the specific anatomical subset of LM disease.

Methods

This is a retrospective, observational, multicenter, international, and blinded study including patients with LM stenoses. Cases with significant ostial LM disease were excluded. QFR was calculated from conventional angiograms at blinded fashion with respect to FFR.

Results

Sixty-seven patients with LM stenoses were analyzed. Overall, LM had intermediate severity, both from angiographic (diameter stenosis [%DS] 43.8 ± 11.1%) and functional perspective (FFR 0.756 ± 0.105). Mean QFR was 0.733 ± 0.159. Correlation between QFR and FFR was moderate (r = 0.590). Positive and negative predictive value, sensitivity and specificity were 85.4%, 64%, 85.4%, and 69.6% respectively. Classification agreement of QFR and FFR in terms of functional stenosis severity was 78.1%. Area under the receiver operating characteristics of QFR using FFR as reference was 0.82 [95% confidence interval [CI], 0.71−0.93], and significantly better than angiographic evaluation including %DS (area under the receiver-operating characteristic curve [AUC] 0.45 [95% CI, 0.32−0.58], p < 0.001) and minimum lumen diameter (AUC 0.60 [95% CI, 0.47−0.74], p < 0.001).

Conclusions

Compared with FFR, QFR has acceptable diagnostic performance in determining the functional relevance of LM stenosis, being better than conventional angiographic assessment. Nonetheless, caution should be taken when applying functional angiography techniques for the assessment of LM stenosis given its particular anatomical characteristics.     

Increased plasma endothelin levels in angina patients with rapid coronary artery disease progression.

AIMS: To investigate the association between plasma endothelin levels and rapid coronary artery disease progression, as assessed by quantitative angiography. METHODS AND RESULTS: Changes in diameter were assessed in 224 coronary stenoses of 92 consecutive patients (62 men) with chronic stable angina pectoris who were on a waiting list for routine coronary angioplasty and underwent coronary angiography on two occasions: the first (diagnostic) angiogram was carried out at study entry and the second 5.5+/-3.0 months later, immediately prior to coronary angioplasty. A digital quantitative angiographic analysis system was used to assess differences in stenosis diameter between the first and second angiogram. Plasma immunoreactive endothelin levels were estimated by radioimmunoassay at study entry. Rapid coronary artery disease progression occurred in 29 (31.5%) patients according to pre-established criteria: 12 (41%) had a > or =10% diameter reduction of at least one pre-existing stenosis > or =50%, 10 (34%) had a > or =30% diameter reduction of a pre-existing stenosis <50%, 5 (17%) patients developed a new stenosis and 2 (7%) had progression of a lesion to total occlusion by the second angiogram. Baseline demographic, clinical and angiographic data were similar in patients with and without stenosis progression. Plasma endothelin levels were significantly higher in patients with rapid disease progression than in those without (5.7+/-2.0 pg. ml(-1)vs 3.9+/-1.6 pg. ml(-1), P<0.001). Multiple logistic regression analysis revealed that endothelin was an independent predictor of disease progression (P=0.001). Moreover, endothelin levels above 4.26 pg. ml(-1)(the median of the total endothelin concentrations) were associated with a sixfold increase in the risk of developing rapid stenosis progression. CONCLUSIONS: Plasma endothelin is raised in patients with coronary artery disease progression and may be a marker of risk of rapid stenosis progression. Endothelin may also play a pathogenic role in this process.     

Digital geometric measurements in comparison to cinefilm analysis of coronary artery dimensions

Six months follow-up post-PTCA angiograms from 31 patients were acquired digitally and on cinefilm and used for a comparison of geometric coronary measurements at the site of the previous dilatation. On 70 images of 34 coronary segments quantitative analysis was performed both on-line, using the Automated Coronary Analysis package of the Philips Digital Cardiac Imaging System (DCI, pixel matrix 512 × 512) and off-line, using the Cardiovascular Angiography Analysis System (CAAS). With the CAAS a cine-video conversion is performed and a 6.9 × 6.9 mm region of interest from the 18 × 24 mm cineframe is digitized into a 512 × 512 pixel matrix. In both systems the vascular contours are assessed by means of operator-independent edge detection algorithms. The angiographic catheter was used for calibration. Best agreement between DCI and CAAS was found for obstruction diameter and minimal luminal diameter, respectively (r = 0.82; y = 0.12 + 0.97x; SEE = 0.29). The reconstructed reference diameter related to a computed reference contour yields lower correlation (r = 0.76; y = 0.27 + 0.91x; SEE = 0.37). Worst results were obtained from the relative measure of percent diameter stenosis as well as from the derived parameter of plaque area. The on-line digital approach of geometric coronary assessments provides good agreement with cinefilm analysis when direct measurements of coronary dimensions are applied. © 1993 Wiley-Liss, Inc.     

Internal mammary artery angiography should be a routine component of diagnostic coronary angiography

Left internal mammary artery (LIMA) angiography was performed with diagnostic coronary angiography in 130 cases for which the coronary findings made use of the LIMA as a bypass graft a consideration. In 98% of the cases the approach to LIMA angiography was femoral with a 5F LIMA catheter first directed into the proximal subclavian and then advanced over a guidewire placed into the distal subclavian well beyond the origin of the LIMA. After withdrawing the wire the catheter was brought proximally to selectively can-nulate and visualize the LIMA with nonionic contrast media. The only complication was a single transient occipital visual field loss. LIMA caliber too narrow to permit use as a graft was found twice, LIMA occlusion unrelated to prior surgery was found once, and LIMA occlusion related to prior surgery was found twice. Subclavian and/or vertebral stenosis was present five times. Large proximal branches of the LIMA best identified prior to surgery were present 12 times. Based on this experience, LIMA angiography (1) can be performed safely with a high degree of success, (2) demonstrates significant findings in 15% of cases, and 3) should therefore be performed whenever coronary angiographic findings make it appropriate to consider LIMA to coronary artery bypass grafting.     

Limitations in the use of five french coronary catheters

Five french (5F) catheters are being widely promoted for use in patients undergoing day case angiography including coronary angiography. Although there are theoretical advantages to this practice there are also potential disadvantages. We reviewed various performance parameters of four different brands of 5F coronary catheter and compared them with performance of the six (6F) and eight french (8F) coronary catheters used in routine coronary angiography. All the 5F catheters performed significantly less satisfactorily than the 6F and 8F catheters. 5F coronary catheters cannot be recommended for routine transfemoral coronary angiography.     

Double guide double wrist 5F left coronary artery transradial percutaneous coronary intervention and the X-Kiss technique

Percutaneous coronary intervention for bifurcated anatomy, particularly at the proximal left coronary artery site, requires guide catheters (GC) of at least 6 french and preferably larger in diameter. We describe a new trans-radial approach more suitable for small artery size: the simultaneous use of both radial arteries for double cannulation of the LMCA with 5F GC: each GC will target either the LM/LAD or the LM/CX artery (or LM-LAD/LM-LAD-1st diagonal branch) stenoses. The technique successfully was applied to 5 cases. When the technique was used for distal left main coronary artery stenoses (3 cases), a special crogss-like configuration obtained when guide catheters, coronary wires and balloons kissed was observed.     

Quantitative coronary angiography in the estimation of the functional significance of coronary stenosis: Correlations with dobutamine-atropine stress test

Objectives. The purpose of this study was to determine the predictive value of quantitative coronary angiography in the assessment of the functional significance of coronary stenosis as judged from the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography.Background. Coronary angiography is the reference method for assessment of the accuracy of noninvasive diagnostic imaging techniques to detect the presence of significant coronary stenosis. However, use of arbitrary cutoff criteria for the interpretation of angiographic data may considerably influence the true diagnostic accuracy of the technique investigated.Methods. Thirty-four patients without previous myocardial infarction and with single-vessel coronary stenosis were studied with both quantitative angiography and dobutamine-atropine stress echocardiography. Two different techniques of quantitative angiographic analysis—edge detection and videodensitometry—were used for measurement of minimal lumen diameter, percent diameter stenosis and percent area stenosis. Two-dimensional echocardiographic images were collected during incremental doses of intravenous dobutamine and later analyzed using a 16-segment left ventricular model. Angiographic cutoff criteria were derived from receiver-operating curves to define the functional significance of coronary stenosis on the basis of dobutamineatropine stress echocardiography.Results. The angiographic cutoff values with the best predictive value for the development of left ventricular wall motion abnormalities during dobutamine-atropine stress echocardiography were minimal lumen diameter of 1.07 mm, percent diameter stenosis of 52% and percent area stenosis of 75%. Minimal lumen diameter was found to have the best predictive value for a positive dobutamine stress test (odds ratio 51, sensitivity 94%, specificity 75%).Conclusions. Automated quantitative angiographic measurement of animal lumen diameter is a practical and useful index for determining both the anatomic and functional significance of coronary stenosis, and a value of 1.07 mm is the best predictor for a positive dobutamine stress test.