Coronary flow capacity: concept, promises, and challenges

Hoef, Tim P. van de; Echavarría‐Pinto, Mauro; Escaned, Javier; Piek, Jan J.

doi:10.1007/s10554-017-1125-z

Cited by 11 publications

(8 citation statements)

References 22 publications

(45 reference statements)

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“…The observed low CV risk in patients with preserved CFR and impaired maximal MBF assessed globally for the entire left ventricular myocardium parallels the coronary vascular territory-specific findings in the invasive literature; patients with decreased fractional flow reserve (a ratio of two pressures under maximal hyperemia; thus, reflecting a ratio of two maximal MBFs) but preserved coronary flow velocity reserve have predominantly focal epicardial stenosis but still have low risk of adverse CV outcomes. 5, 26 Whether this group potentially represents patients that may be best served by optimal medical therapy for CAD management, with revascularization reserved for refractory symptoms, needs further investigation in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Integrated Noninvasive Physiological Assessment of Coronary Circulatory Function and Impact on Cardiovascular Mortality in Patients With Stable Coronary Artery Disease

et al. 2017

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Background It is suggested that the integration of maximal myocardial blood flow (MBF) and coronary flow reserve (CFR), termed coronary flow capacity, allows comprehensive evaluation of patients with known or suspected stable coronary artery disease. As management decisions are predicated on clinical risk, we sought to determine the independent and integrated value of maximal MBF and CFR for predicting cardiovascular death. Methods MBF and CFR were quantified in 4,029 consecutive patients (median age 66 years, 50.5% women) referred for rest/stress myocardial perfusion positron emission tomography scans from January 2006 to December 2013. The primary outcome was cardiovascular mortality. Maximal MBF<1.8 ml·g-1·min-1 and CFR<2 were considered impaired. Four patient groups were identified based on the concordant or discordant impairment of maximal MBF or CFR. Association of maximal MBF and CFR with cardiovascular death was assessed using Cox and Poisson regression analyses. Results A total of 392 (9.7%) cardiovascular deaths occurred over a median follow-up of 5.6 years. CFR was a stronger predictor of cardiovascular mortality than maximal MBF beyond traditional cardiovascular risk factors, left ventricular ejection fraction, myocardial scar and ischemia, rate-pressure-product, type of radiotracer or stress agent used, and revascularization post-scan (adjusted Hazard Ratio, HR [95% Confidence-Interval, CI]: 1.79 [1.38-2.31], p<0.001 per unit decrease in CFR after adjustment for maximal MBF and clinical covariates, and 1.03 [0.84-1.27], p=0.8 per unit decrease in maximal MBF after adjustment for CFR and clinical covariates). In univariable analyses, patients with concordant impairment of CFR and maximal MBF had high cardiovascular mortality of 3.3% (95%CI: 2.9-3.7%) per year. Patients with impaired CFR but preserved maximal MBF had an intermediate cardiovascular mortality of 1.7% (95% CI: 1.3-2.1%) per year; these patients were predominantly women (70%). Patients with preserved CFR but impaired maximal MBF had low cardiovascular mortality of 0.9% (95% CI: 0.6-1.6%) per year. Patients with concordantly preserved CFR and maximal MBF had the lowest cardiovascular mortality of 0.4% (95% CI: 0.3-0.6%) per year. In multivariable analysis, the cardiovascular mortality risk gradient across the four concordant or discordant categories was independently driven by impaired CFR irrespective of impairment in maximal MBF. Conclusions CFR is a stronger predictor of cardiovascular mortality than maximal MBF. Concordant and discordant categories based on integrating CFR and maximal MBF identify unique prognostic phenotypes of patients with known or suspected coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Integrated Noninvasive Physiological Assessment of Coronary Circulatory Function and Impact on Cardiovascular Mortality in Patients With Stable Coronary Artery Disease

et al. 2017

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“…Following the remaining concerns on the sensitivity of CFR to resting flow conditions, a novel concept was introduced termed coronary flow capacity ( Fig. 5; [55,[58][59][60]). This concept assumes that myocardial ischaemia is unlikely in settings where the vasodilator reserve (CFR) is normal, or where maximal blood flow is normal, and that myocardial ischaemia is likely in settings where both vasodilator reserve and maximal flow are severely reduced.…”

Section: Coronary Flow (Velocity) Reservementioning

confidence: 99%

Invasive coronary physiology: a Dutch tradition

et al. 2020

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Invasive coronary physiology has been applied since the early days of percutaneous transluminal coronary angioplasty, and has become a rapidly emerging field of research. Many physiology indices have been developed, tested in clinical studies, and are now applied in daily clinical practice. Recent clinical practice guidelines further support the use of advanced invasive physiology methods to optimise the diagnosis and treatment of patients with acute and chronic coronary syndromes. This article provides a succinct review of the history of invasive coronary physiology, the basic concepts of currently available physiological parameters, and will particularly highlight the Dutch contribution to this field of invasive coronary physiology.

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“…Smatra se da je koronarna rezerva protoka značajna za identifikaciju klinički značajnih abnormalnosti koronarnog protoka, posebno kod pacijenata izloženih riziku od neželjenih događaja (6). Klinička istraživanja su pokazala da je CFR smanjena kod pacijenata sa hipertenzijom i predstavlja nezavisni prediktor srčanog mortaliteta (7). Međutim, prognostička uloga CFR i promene koronarnog protoka kod asimptomatskih pacijenata, sa očuvanom sistolnom funkcijom leve komore u mirovanju, mnogo je manje istraživana.…”

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The prognostic significance of coronary flow reserve in the risk stratification of patients with chronic total occlusion of the right coronary artery and the intermediary stenosis of the left coronary artery

Hadži-Tanović¹,

Bošković²,

Dedić³

et al. 2020

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Introduction: Coronary Flow Reserve (CFR) is a clinically useful, non-invasive diagnostic method for assessing the functional ability of coronary arteries and it is important for their long-term follow-up in patients. However, CFR has not always been sufficiently investigated in previous studies. Objective: To examine the prognostic significance of CFR in the risk stratification of patients with chronic total occlusion of the right coronary artery (RCA) and the intermediary stenosis of the left coronary artery (LAD). Material and Methods: Number of 71 patients, mean age 64 ± 7 years, (84%) patients male, having LAD stenosis, diameter 50-70%, and CTO of RCA, were referred for noninvasive estimation of functional significance of LAD stenosis. Transthoracic Doppler echocardiography was used to obtain coronary flow velocities in the distal segment of LAD. Patients were followed for the mean period of 18.3 ± 7.1 months for the occurrence of composite end point including cardiovascular death, myocardial infarction, bypass surgery and PCI. Results: During the follow-up period, there were a total of 23 adverse events (4 deaths, 2 myocardial infarction, 7 bypass surgeries and 10 PCI). Patients with CFR < 2 had significantly more adverse events (n = 9; 56.3% vs. n = 14; 25.5%; p = 0.021), they were significantly older (68 ± 9 vs. 62 ± 6; p = 0.011), with a higher incidence of a positive family history (14; 87.5% vs. 26; 47.3%; p = 0.039), as well as a significantly higher frequency of three-dose coronary disease (14; 87.5% vs. 30; 54.5%; p = 0.017). Using Kaplan-Meier estimator, we obtained that patients with CFR < 2 have a significantly shorter average period without unwanted event (15.4 ± 2.8 months vs 23.5 ± 1.1 months, Log Rank 7.407; p = 0.008). Conclusion: CFR plays an important role in stratifying the risk of patients with CTO of RCA and the intermediary stenosis of LAD.

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Coronary flow capacity: concept, promises, and challenges

Cited by 11 publications

References 22 publications

Integrated Noninvasive Physiological Assessment of Coronary Circulatory Function and Impact on Cardiovascular Mortality in Patients With Stable Coronary Artery Disease

Integrated Noninvasive Physiological Assessment of Coronary Circulatory Function and Impact on Cardiovascular Mortality in Patients With Stable Coronary Artery Disease

Invasive coronary physiology: a Dutch tradition

The prognostic significance of coronary flow reserve in the risk stratification of patients with chronic total occlusion of the right coronary artery and the intermediary stenosis of the left coronary artery

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