Coronary Flow Reserve During Coronary Angioplasty in Patients With a Recent Myocardial Infarction: Relation to Stenosis and Myocardial Viability

Claeys, Marc J.; Vrints, C.; Bosmans, Johan; Krug, Bruno; Blockx, P.; Snoeck, J

doi:10.1016/s0735-1097(96)00386-5

Cited by 59 publications

(25 citation statements)

References 43 publications

(50 reference statements)

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“…8,10,11 Coronary flow reserve and fractional flow reserve after acute myocardial infarction have both been found to be predictive of myocardial recovery, albeit with variable accuracy. [31][32][33][34] However, supportive evidence correlating fractional flow reserve with viability is limited in the acute setting, when microvascular derangement is at its peak, potentially affecting the accuracy of fractional flow reserve in this context. The dependence of coronary flow reserve on prevailing hemodynamic conditions and epicardial coronary disease has also limited its applicability.…”

Section: Phasic Wia Versus Means-per-beat Assessment Of Microvascularmentioning

confidence: 99%

Coronary Wave Energy

Silva

Foster

Guilcher

et al. 2013

Circ: Cardiovascular Interventions

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Background-Revascularization after acute coronary syndromes provides prognostic benefit, provided that the subtended myocardium is viable. The microcirculation and contractility of the subtended myocardium affect propagation of coronary flow, which can be characterized by wave intensity analysis. The study objective was to determine in acute coronary syndromes whether early wave intensity analysis-derived microcirculatory (backward) expansion wave energy predicts late viability, defined by functional recovery. Methods and Results-Thirty-one patients (58±11 years) were enrolled after non-ST elevation myocardial infarction.Regional left ventricular function and late-gadolinium enhancement were assessed by cardiac magnetic resonance imaging, before and 3 months after revascularization. The backward-traveling (microcirculatory) expansion wave was derived from wave intensity analysis of phasic coronary pressure and velocity in the infarct-related artery, whereas mean values were used to calculate hyperemic microvascular resistance.

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Section: Phasic Wia Versus Means-per-beat Assessment Of Microvascularmentioning

confidence: 99%

Coronary Wave Energy

Silva

Foster

Guilcher

et al. 2013

Circ: Cardiovascular Interventions

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“…Nevertheless, CFR measurements are subject to a high interpatient variability that is related to a variety of physiological 23,24 and pathophysiological conditions. [25][26][27] The absolute CFR Յ2.5 as a definition of impaired CFR after PTCA is based on data obtained in a selected patient population. A CFR Ͼ2.5 after successful PTCA is in accordance with a rCFR Ͼ0.80 (Figure 1).…”

Section: Relative Cfrmentioning

confidence: 99%

Immediate and Long-Term Effect of Balloon Angioplasty or Stent Implantation on the Absolute and Relative Coronary Blood Flow Velocity Reserve

et al. 1998

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Background-There is controversy regarding the immediate and long-term effects of PTCA on the coronary flow reserve. Methods and Results-A total of 54 patients with 1-vessel disease and normal left ventricular function were studied after balloon angioplasty (nϭ34) or stent implantation (nϭ20). Distal coronary blood flow velocity reserve (CFR) was defined as the ratio of adenosine-induced hyperemic versus baseline blood flow velocity with a 0.014-in Doppler guidewire. The relative CFR was defined as the ratio of the distal CFR and the reference CFR measured in the normal adjacent coronary artery. Hemodynamic and angiographic measurements were performed before and directly after balloon angioplasty or stent implantation and at 6-month follow-up. CFR after PTCA Յ2.5 was defined as an impaired CFR. Immediately after PTCA, CFR improved toward the range of the reference artery CFR. In both the balloon-treated and the stent-treated groups, initial high CFR values decreased and impaired CFR values increased at follow-up toward the values of the reference CFR in patients without restenosis. Impaired CFR after balloon angioplasty (33%) or stent implantation (58%) in patients without restenosis was related to an increased baseline flow velocity that normalized at follow-up. Patients with an increase of CFR after stenting were characterized by an unaltered baseline flow velocity and an increased adenosine-induced hyperemic flow velocity. Conclusions-An impaired CFR (Յ2.5) is a frequent finding after balloon angioplasty or stent implantation as a result of a high baseline flow velocity. Normalization of impaired CFR at follow-up in patients without restenosis was associated with a decline of the baseline flow velocity after both balloon angioplasty and stent implantation, supporting the contention that this phenomenon relates to a slow recovery of autoregulation of the microvascular bed. (Circulation. 1998;98:2133-2140.)Key Words: angioplasty Ⅲ stents Ⅲ blood flow I n a classic study, Gould et al 1 introduced the curvilinear relationship between coronary lesion severity and flow reserve distal to the narrowing. Subsequently, several clinical studies evaluated this relationship in the setting of coronary angioplasty using digital subtraction techniques, 2 intracoronary blood flow velocity and pressure measurements, 3,4 or PET.5 A recently published large, multicenter trial (DEBATE study) demonstrated that impaired coronary flow reserve (Յ2.5) immediately after balloon angioplasty was associated with a high incidence of recurrent angina, need for revascularization procedures, and a high restenosis rate. 6 The hypothesis that impaired coronary flow reserve after balloon angioplasty is due to residual lumen obstruction was supported by studies showing a normalization of impaired coronary flow reserve after optimal vascular lumen enlargement by stent implantation. 7,8 However, other studies demonstrated a spontaneous improvement of impaired coronary flow reserve after balloon angioplasty without adjunctive coronary intervention du...

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“…4 Doppler guidewires have been used extensively in the AMI setting. [5][6][7][8][9][10][11] Specific coronary flow velocity patterns 7,11 and a severe impairment of coronary flow velocity reserve (CVR) 10 have been documented in patients with AMI with no reflow after primary angioplasty.…”

mentioning

confidence: 99%