Potential and limitations of wave intensity analysis in coronary arteries

Siebes, Maria; Kolyva, Christina; Verhoeff, Bart-Jan; Piek, Jan J.; Spaan, Jos A. E.

doi:10.1007/s11517-009-0448-x

Cited by 41 publications

(46 citation statements)

References 28 publications

(43 reference statements)

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“…This might be particularly relevant for the measurement of eFCW as coronary stenosis diminishes the magnitude of forward waves measured distal to it to a greater extent than backward waves which originate distally. 19 This could have led to a type II error for eFCW, but does not negate the positive result observed for the BEW. The size of the study is such that additional variables such as stenosis severity cannot be controlled for statistically.…”

Section: Limitationsmentioning

confidence: 94%

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Diastolic Backward-Traveling Decompression (Suction) Wave Correlates With Simultaneously Acquired Indices of Diastolic Function and Is Reduced in Left Ventricular Stunning

Ladwiniec

White

Nijjer

et al. 2016

Circ: Cardiovascular Interventions

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4As coronary flow is predominantly diastolic, the predominant driver of coronary flow, particularly in the left coronary artery, 5 is thought to be the BEW (or suction wave), generated by myocardial microcirculatory decompression in early diastole. 4 It has been suggested that the measurement of the BEW might have future utility in testing myocardial viability at the time of percutaneous coronary intervention (PCI) 6 or even predicting the timing of intervention in aortic valve disease. 7 The BEW has been shown to correlate with parameters known to be associated with LV diastolic performance, 4 specifically LV hypertrophy. However, in patients with coronary disease, coronary wave intensity has not previously been compared with simultaneously acquired LV hemodynamics, fromBackground-Wave intensity analysis can distinguish proximal (propulsion) and distal (suction) influences on coronary blood flow and is purported to reflect myocardial performance and microvascular function. Quantifying the amplitude of the peak, backwards expansion wave (BEW) may have clinical utility. However, simultaneously acquired wave intensity analysis and left ventricular (LV) pressure-volume loop data, confirming the origin and effect of myocardial function on the BEW in humans, have not been previously reported. Methods and Results-Patients with single-vessel left anterior descending coronary disease and normal ventricular function (n=13) were recruited prospectively. We simultaneously measured LV function with a conductance catheter and derived wave intensity analysis using a pressure-low velocity guidewire at baseline and again 30 minutes after a 1-minute coronary balloon occlusion.

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Section: Limitationsmentioning

confidence: 94%

“…Measurement of forward waves distal to a coronary stenosis can have the effect of abrogating them. 19 The effect of significant coronary stenoses on the eFCW amplitude may therefore have blunted any observable association.…”

Section: Wave Intensity Analysis and Systolic Functionmentioning

confidence: 99%

Diastolic Backward-Traveling Decompression (Suction) Wave Correlates With Simultaneously Acquired Indices of Diastolic Function and Is Reduced in Left Ventricular Stunning

Ladwiniec

White

Nijjer

et al. 2016

Circ: Cardiovascular Interventions

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“…The reasons for this may be the presence of large reflection sites close to the measurement site in the relatively short coronary arteries or the neglect of the reservoir pressure in the calculations. Because of the importance of the wave speed in the separation of forward and backward waves, which is particularly important in the coronary arteries, it is important to resolve these difficulties if wave intensity analysis is to contribute to our understanding of coronary artery dynamics [17].…”

Section: The Sum Of Squares Methodsmentioning

confidence: 99%

An introduction to wave intensity analysis

Parker

2009

Med Biol Eng Comput

271

324

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Wave intensity analysis applies methods first used to study gas dynamics to cardiovascular haemodynamics. It is based on the method of characteristics solution of the 1-D equations derived from the conservation of mass and momentum in elastic vessels. The measured waveforms of pressure P and velocity U are described as the summation of successive wavefronts that propagate forward and backward through the vessels with magnitudes dP (+/-) and dU (+/-). The net wave intensity dPdU is the flux of energy per unit area carried by the wavefronts. It is positive for forward waves and negative for backward waves, providing a convenient tool for quantifying the timing, direction and magnitude of waves. Two methods, the PU-loop and the sum of squares, are given for calculating the wave speed c from simultaneous measurements of P and U at a single location. Given c, it is possible to separate the waveforms into their forward and backward components. Finally, the reservoir-wave hypothesis that the arterial and venous pressure can be conveniently thought of as the sum of a reservoir pressure arising from the total compliance of the vessels (the Windkessel effect) and the pressure associated with the waves is discussed.

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“…21 Wave energy was obtained by integrating the area under each separated wave, normalized to the sampling interval.…”

Section: What the Study Addsmentioning

confidence: 99%

Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis

Rolandi

Wiegerinck

Casadonte

et al. 2016

Circ: Cardiovascular Interventions

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Background-Aortic valve stenosis (AS) can cause angina despite unobstructed coronary arteries, which may be related to increased compression of the intramural microcirculation, especially at the subendocardium. We assessed coronary wave intensity and phasic flow velocity patterns to unravel changes in cardiac-coronary interaction because of transcatheter aortic valve implantation (TAVI). Methods and Results-Intracoronary pressure and flow velocity were measured at rest and maximal hyperemia in undiseased vessels in 15 patients with AS before and after TAVI and in 12 control patients. Coronary flow reserve, systolic and diastolic velocity time integrals, and the energies of forward (aorta-originating) and backward (microcirculatoryoriginating) coronary waves were determined. Coronary flow reserve was 2.8±0.2 (mean±SEM) in control and 1.8±0.1 in AS (P<0.005) and was not restored by TAVI. Compared with control, the resting backward expansion wave was 45% higher in AS. The peak of the systolic forward compression wave was delayed in AS, consistent with a delayed peak aortic pressure, which was partially restored after TAVI. The energy of forward waves doubled after TAVI, whereas the backward expansion wave increased by >30%. The increase in forward compression wave with TAVI was related to an increase in systolic velocity time integral. AS or TAVI did not alter diastolic velocity time integral. Conclusions-Reduced coronary forward wave energy and systolic velocity time integral imply a compromised systolic flow velocity with AS that is restored after TAVI, suggesting an acute relief of excess compression in systole that likely benefits subendocardial perfusion. Vasodilation is observed to be a major determinant of backward waves. (Circ Cardiovasc Interv. 2016;9:e002356.

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Potential and limitations of wave intensity analysis in coronary arteries

Cited by 41 publications

References 28 publications

Diastolic Backward-Traveling Decompression (Suction) Wave Correlates With Simultaneously Acquired Indices of Diastolic Function and Is Reduced in Left Ventricular Stunning

Diastolic Backward-Traveling Decompression (Suction) Wave Correlates With Simultaneously Acquired Indices of Diastolic Function and Is Reduced in Left Ventricular Stunning

An introduction to wave intensity analysis

Transcatheter Replacement of Stenotic Aortic Valve Normalizes Cardiac–Coronary Interaction by Restoration of Systolic Coronary Flow Dynamics as Assessed by Wave Intensity Analysis

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