Assessing the hemodynamic significance of coronary artery stenosis: Analysis of translesional pressure-flow velocity relations in patients

Donohue, Thomas J.; Kern, Morton J.; Aguirre, Frank V.; Bach, Richard G.; Wolford, Thomas; Bell, Calvin; Segal, Jonathan H.

doi:10.1016/0735-1097(93)90049-7

Cited by 167 publications

(52 citation statements)

References 34 publications

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“…Coronary flow-derived parameters include the diastolic to systolic velocity ratio and proximal to distal velocity ratio. 23 Both parameters were, however, shown to have limited diagnostic accuracy for myocardial ischemia when compared with CFVR. 24 Pressurederived parameters that have been investigated previously include the transstenotic pressure gradient during baseline conditions, 25 resting distal pressure to aortic pressure ratio, 26 Data are presented as mean±SD or median (interquartile range).…”

Section: Evaluation Of Functional Lesion Severity Without Hyperemiamentioning

confidence: 99%

Diagnostic Accuracy of Combined Intracoronary Pressure and Flow Velocity Information During Baseline Conditions

Hoef

Nolte²,

Damman³

et al. 2012

Circ: Cardiovascular Interventions

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Background-The assessment of functional coronary lesion severity using intracoronary physiological parameters such as coronary flow velocity reserve and the more widely used fractional flow reserve relies critically on the establishment of maximal hyperemia. We evaluated the diagnostic accuracy of the stenosis resistance index during nonhyperemic conditions, baseline stenosis resistance index, compared with established hyperemic intracoronary hemodynamic parameters, because achievement of hyperemia can be cumbersome in daily clinical practice. Methods and Results-A total of 228 patients, including 299 lesions (mean stenosis diameter 55%±11%), underwent myocardial perfusion scintigraphy for documentation of reversible perfusion defects. Distal coronary pressure and flow velocity were assessed with sensor-equipped guidewires during baseline and maximal hyperemia, induced by an intracoronary bolus of adenosine (20-40 μg). We determined stenosis resistance (SR) during baseline and hyperemic conditions as well as fractional flow reserve and coronary flow velocity reserve. The discriminative value for myocardial ischemia on myocardial perfusion scintigraphy of all parameters was compared using receiver-operating-characteristic curves. Baseline SR showed good agreement with myocardial perfusion scintigraphy.

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Section: Evaluation Of Functional Lesion Severity Without Hyperemiamentioning

confidence: 99%

Diagnostic Accuracy of Combined Intracoronary Pressure and Flow Velocity Information During Baseline Conditions

Hoef

Nolte²,

Damman³

et al. 2012

Circ: Cardiovascular Interventions

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“…In the previous studies, Donohue et al [40] concluded that within branching coronary circulations, translesional flow velocity ratios < 1.7 are associated with translesional pressure gradients < 30 mmHg.…”

Section: Translesional Hemodynamic Variablesmentioning

confidence: 97%

Clinical important hemodynamic characteristics for serial stenosed coronary artery

Bernad¹,

Bernad²,

Totorean³

et al. 2015

Int. J. DNE

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Effects of serial stenosis on coronary hemodynamics are investigated in the human right coronary artery (RCA) by blood flow analysis. The 3D reconstruction of the geometry of the stenosed coronary artery uses the multislice computerized tomography serial images method. Results of the numerical analysis present the hemodynamic characteristics of the serial stenosed coronary artery throughout the flow separation, pressure drop and wall shear stress. The pressure loss associated with recirculation region created in the vicinity of each constriction was found to be large. In two stenoses the corresponding pressure gradients are around 30 mmHg and correspond to the stenosis with fractional flow reserve-FFR < 0.7 (value associated to the severe stenosis). Distal to the stenosis, flow is associated with fluctuations in the wall shear stress and vorticity. Both FFR and CFD analysis help identify intermediate lesions that require intervention and reduce unnecessary procedures with potential complications.

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“…However, because of the complexity in the interpretation of CVR, pressurederived FFR is the preferred measurement for lesion assessment and outcome of PCI. Coronary physiologic measurements associated with major clinical outcomes are supported by numerous studies (Table 23) (632,637).…”

Section: Coronary Artery Pressure Andmentioning

confidence: 98%

“…IVUS increasingly is also being used to measure the volume of intimal hyperplasia in experimen- On the other hand, CVR is the ratio of hyperemic to basal flow and reflects flow resistance through the epicardial artery and the microvascular bed. CVR less than 2.0 is positively correlated to abnormal stress perfusion imaging (632)(633)(634). In some cases, the uncertainty as to whether the impaired flow reserve is due to the target stenosis or to an abnormal microcirculation may be reduced by use of relative coronary flow reserve (rCVR, which is equal to CVR of the target vessel divided by CVR of the reference vessel).…”

Section: Coronary Artery Pressure Andmentioning

confidence: 99%

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

Wilkins¹

2006

Circulation

350

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Assessing the hemodynamic significance of coronary artery stenosis: Analysis of translesional pressure-flow velocity relations in patients

Cited by 167 publications

References 34 publications

Diagnostic Accuracy of Combined Intracoronary Pressure and Flow Velocity Information During Baseline Conditions

Diagnostic Accuracy of Combined Intracoronary Pressure and Flow Velocity Information During Baseline Conditions

Clinical important hemodynamic characteristics for serial stenosed coronary artery

ACC/AHA/SCAI Practice Guidelines, February 21, 2006

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