Experimental validation of quantitative coronary arteriography for determining pressure-flow characteristics of coronary stenosis.

Gould, K. Lance; Kelley, Katharine O.; Bolson, Edward L.

doi:10.1161/01.cir.66.5.930

Cited by 226 publications

(50 citation statements)

References 26 publications

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“…Gould et al have shown that the calculated pressure loss (∆P) across an area of stenosis can be described by the following simplified equation: ∆P=FV+SV 2 . 18 IVUS and FFR for the assessment of myocardial ischemia at Ehime University Graduate School of Medicine. Patients who had severe left ventricular (LV) hypertrophy, hypertrophic cardiomyopathy, severe systolic dysfunction, an infarct-related artery, significant valvular disease, left main trunk-left anterior descending coronary artery or left main trunk-left circumflex coronary artery true bifurcation lesion in addition to a history of PCI in the target vessel, lesion length >60 mm in the left coronary artery, target vessel implanted with ≥2 stents, or severe respiratory disease with home oxygen therapy were excluded from the present study.…”

Section: Ivus-ffrmentioning

confidence: 99%

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Seike

Uetani

Nishimura

et al. 2018

Circ J

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Background: Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Intravascular ultrasound (IVUS) is an intracoronary imaging method that provides information about lumen and vessel morphology. Previous studies on the expanded use of IVUS to identify functional ischemia have noted an association between anatomy and physiology, but IVUS-derived minimum lumen area (MLA) has a weak-moderate correlation with myocardial ischemia compared with FFR. We developed a method to calculate FFR using IVUS-derived anatomical information for the assessment of myocardial ischemia. The aims of this study were to investigate the relationship between wire-based FFR and IVUS-derived FFR (IVUS-FFR) and to compare the usefulness of IVUS-FFR and IVUS-derived MLA for functional assessment. Methods and Results:We retrospectively analyzed 50 lesions in 48 patients with coronary stenosis who underwent IVUS and FFR simultaneously. IVUS-FFR was calculated using our original algorithm and fluid dynamics. Mean percent diameter stenosis determined on quantitative coronary angiography and on FFR was 56.4±10.7 and 0.69±0.08, respectively. IVUS-FFR had a stronger linear correlation with FFR (R=0.78, P<0.001; root mean square error, 0.057 FFR units) than with IVUS-derived MLA (R=0.43, P=0.002).Conclusions: IVUS-FFR may be a more valuable method to identify myocardial ischemia, compared with IVUS-derived MLA.

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Section: Ivus-ffrmentioning

confidence: 99%

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Seike

Uetani

Nishimura

et al. 2018

Circ J

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“…The accuracy of quantitative coronary arteriography has been well established in our laboratory'6"17"19 and in the extensive validation studies of Brown et a140 and Gould et al 41 Coronary sinus thermodilution techniques were used to measure total coronary sinus blood flow. Although this method is unable to measure the perfusion in specific transmural layers or different left ventricular regions or rapid changes in coronary blood flow, 42 Ganz and coworkers2' found a high correlation between coronary sinus flow measured by this technique and by timed collection of venous blood.…”

Section: Limitations Of the Studymentioning

confidence: 99%

Abnormal coronary vasomotion during exercise in patients with normal coronary arteries and reduced coronary flow reserve.

Bortone

Eberli

et al. 1989

Circulation

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A reduced coronary flow reserve has been reported in patients with ischemialike symptoms and normal coronary arteries. In 13 such patients, both coronary vasomotion and flow reserve were studied. The luminal area of the proximal and distal third of the left anterior descending and left circumflex artery were determined by biplane quantitative coronary arteriography using a computer-assisted system. Patients were studied at rest, during submaximal supine bicycle exercise (4.0 minutes, 116 W), and 5 minutes after sublingual administration of 1.6 mg nitroglycerin. Heart rate, mean pulmonary pressure, and mean aortic pressure as well as the percent change of both proximal and distal luminal area were determined. In 10 of the 13 patients, coronary sinus blood flow was measured by coronary sinus thermodilution technique at rest and after dipyridamole infusion (0.5 mg/kg in 15 minutes) 10±5 days after quantitative coronary arteriography. Coronary flow ratio (dipyridamole/rest) and coronary resistance ratio (rest/dipyridamole) were determined in these patients. Patients were divided into two groups according to the behavior of the coronary vessels during exercise (vasodilation, group 1; vasoconstriction, group 2). Coronary vasodilation of the proximal (luminal area +26%, p <0.001) and distal (+45%, p <0.001) artery was observed in seven patients (group 1) during exercise and after sublingual nitroglycerin (+46%, p<0.001; and + 99%, p<0.001, respectively). In group 2 (n=6), however, there was coronary vasoconstriction of the distal vessel segments (-24%, p<0.001) during exercise, whereas the proximal coronary artery showed vasodilation (+26%, p<0.001) during exercise. After sublingual nitroglycerin, both vessel segments elicited vasodilation (distal coronary, +44%, p<0.001; proximal coronary artery, + 47%, p <0.001). Coronary flow ratio amounted to 2.5 in group 1 and 1.2 in group 2 (p <0.05) and coronary resistance ratio to 2.7 in group 1 and to 1.2 in group 2 (p<0.05), respectively. Thus, among patients with ischemialike symptoms and normal coronary arteries, there is a group of patients (group 2) with an abnormal dilator response of the distal coronary arteries to the physiologic dilator stimulus of exercise and a reduced dilator capacity of the resistance vessels after dipyridamole (abnormal coronary vasodilator syndrome). The nature of this exercise-induced distal coronary vasoconstriction is not clear but might be due to an abnormal neurohumoral tone that may cause or contribute to the blunted vascular response during exercise. (Circulation 1989;79:516-527)

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“…Since histologic, echocardiographic, and angiographic studies have shown that most patients with widespread coronary artery disease have diffuse thickening of the arterial wall in angiographically "normal" portions of the vessel, measurements of percent stenosis may not adequately reflect the extent of luminal obstruction in this subgroup of patients with advanced coronary atherosclerosis. [1][2][3][4][5][6][7][8][9][10][11][12][13] Until recently, measurement of the flow reserve in coronary vessels of patients with less severe coronary artery disease has been hampered by methodologic limitations in measuring coronary blood flow in conscious humans and by the lack of a technique for making multiple measurements of maximal coronary flow reserve during a single catheterization. The recent de-velopment and validation of a small subselective coro- …”

mentioning

confidence: 99%

Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease.

1987

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Studies in animals with normal coronary arteries have shown that coronary flow reserve can be predicted by angiographic measurements of arterial stenosis. Studies in man, however, suggest that even quantitative analysis of coronary angiograms cannot predict the physiologic significance of individual coronary lesions. These studies, however, were carried out in patients with either widespread, diffuse coronary artery disease or by measurement techniques that tend to underestimate maximal coronary flow reserve. To determine the relationship between coronary arterial stenosis and coronary flow reserve (CFR) in patients with discrete limited coronary atherosclerosis, we studied 50 patients with a single discrete coronary stenosis in only one or two vessels. The minimum coronary arterial cross-sectional area (mCSA), percent area stenosis (%AS), and percent diameter stenosis in the left and right anterior oblique projections were determined by the Brown/Dodge method of quantitative coronary angiography. A No. 3F coronary Doppler catheter was placed immediately proximal to the lesion. Measurements of CFR were obtained by intracoronary administration of papaverine in doses sufficient to provide maximal arteriolar vasodilation. In 25 patients, a translesional pressure gradient was obtained with an angioplasty catheter. CFR measured in patients with coronary artery disease was compared with that in 13 patients with normal coronary vessels. In normal patients, CFR averaged 5.0 + 0.6 (peak/resting velocity ratio; mean + SEM, range 3.7 to 8.2). In patients with limited coronary artery disease, CFR was closely correlated with %AS (r = .85), mCSA (r = .79), and the translesional pressure gradient (r = .83). Additionally, the most severe percent diameter stenosis in either the left or right anterior oblique view was also highly correlated with CFR (r-.82). Importantly, all arteries with lesions producing less than 70% area stenosis and less than 50% diameter stenosis, or with greater than 2.5 mm2 mCSA had CFR of over 3.5. These results suggest that, in contrast to the poor correlation of percent area and percent diameter stenosis to CFR measured in patients with multivessel coronary artery disease, CFR measured at angiography in patients with discrete, limited coronary artery disease correlates closely with luminal stenosis determined precisely with quantitative coronary angiography. Differences in the extent of diffuse arterial narrowing may account for these discrepancies. Circulation 75, No. 4, 723-732, 1987. IN NORMAL CORONARY ARTERIES, myocardial blood flow is primarily regulated by the resistance of the arteriolar vessels; the epicardial coronary arteries provide little resistance to coronary blood flow under physiologic circumstances.`As a stenosis develops in

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Experimental validation of quantitative coronary arteriography for determining pressure-flow characteristics of coronary stenosis.

Cited by 226 publications

References 26 publications

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Abnormal coronary vasomotion during exercise in patients with normal coronary arteries and reduced coronary flow reserve.

Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease.

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