Continuous Thermodilution Method to Assess Coronary Flow Reserve

Gutiérrez-Barrios, Alejandro; Izaga-Torralba, Elena; Crespo, Fernando Rivero; Gheorghe, Livia; Cañadas, Dolores; Gómez-Lara, Josep; Noval-Morillas, Inmaculada; Rueda, Ricardo Zayas; Calle-Pérez, Germán; Vázquez-García, Rafael; Alfonso, Fernándo

doi:10.1016/j.amjcard.2020.11.011

Cited by 14 publications

(11 citation statements)

References 21 publications

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“…34 They are therefore more likely to find clinical utility when used in microvascular indices. 35,36 Continuous thermodilution has opened the door to new research opportunities investigating coronary flow and R µ in a more accurate and reproducible way than prior methods.…”

Section: Bolus Thermodilutionmentioning

confidence: 99%

“…• performing bolus thermodilution in conjunction with a combined pressure/thermistor coronary guidewire (CFR bolus ), using the inverse of the mean transit times of a bolus of saline at rest and hyperaemia as a surrogate for flow; or • using a novel method that has recently been demonstrated based on the principles of continuous thermodilution (CFR thermo ), which derives absolute coronary flow at rest (Q rest ) and hyperaemia (Q hyper ), from which CFR can be calculated. [19][20]36 Compared with [ 15 O]-H 2 O PET as a gold standard, CFR Doppl has a better agreement than CFR bolus and exhibits less intraobserver variability. 52,53 Nevertheless, the accuracy of CFR Doppl is affected by the difficulty in achieving adequate Doppler signals.…”

Section: Cfr Hyperemic Coronary Flowmentioning

confidence: 99%

See 1 more Smart Citation

Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now

Fawaz¹,

Khan²,

Simpson³

et al. 2023

Interv Cardiol

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The landscape of interventional cardiology is ever evolving. Contemporary practice has shifted from a stenosis-centred approach to the total characterisation of both the epicardial and microcirculatory vessels. Microcirculatory dysfunction plays an important role in the pathophysiology of acute and chronic coronary syndromes, and characterisation of the microcirculation has important clinical consequences. Accordingly, the invasive diagnosis of microcirculatory dysfunction is becoming a key feature of the interventional cardiologist’s toolkit. This review focuses on the methodology underpinning the invasive diagnosis of microvascular dysfunction and highlights the indices that have arisen from these methodologies.

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Section: Bolus Thermodilutionmentioning

confidence: 99%

Section: Cfr Hyperemic Coronary Flowmentioning

confidence: 99%

Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now

Fawaz¹,

Khan²,

Simpson³

et al. 2023

Interv Cardiol

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“…Flow-mediated hyperemia was performed with intracoronary saline infusion via a dedicated micro-catheter (Ray Flow, Hexacath, France) at 20 ml/min for 135 seconds. Continuous recording of the absolute coronary blood flow (ACBF) and MMR was assessed using a dedicated pressure-thermistor coronary wire (Pressurewire X, Abbott, United States) and software (Coroflow, Abbott, United States) as appropriate [11][12][13] .…”

Section: Study Interventionsmentioning

confidence: 99%

Treatment of Slow-flow After Primary Percutaneous Coronary Intervention With Flow-mediated Hyperemia. The Randomized RAIN-FLOW Study

Gomez‐Lara

Gracida

Rivero

et al. 2023

Preprint

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Background: ST-segment Elevation Myocardial Infarction (STEMI) complicated with no reflow after primary percutaneous coronary intervention is associated with adverse outcomes. Although several hyperemic drugs have shown to improve the Thrombolysis In Myocardial Infarction (TIMI) flow, optimal treatment of no reflow remains unsettled. Saline infusion at 20 ml/min via a dedicated microcatheter causes (flow-mediated) hyperemia. The objective is to compare the efficacy of pharmacologic vs. flow-mediated hyperemia in STEMI patients complicated with no reflow. Methods: STEMI patients with no reflow were randomized to receive either adenosine or nitroprusside vs. flow-mediated hyperemia. The angiographic corrected TIMI Frame Count (cTFC) and the Minimal Microcirculatory Resistance (MMR), as assessed with intracoronary pressure-thermistor wire, dedicated microcatheter and thermodilution techniques, were compared after study interventions. Results: Sixty-seven were included (30 allocated to pharmacologic and 37 to flow-mediated hyperemia). After study interventions, cTFC (40.2±23.1 vs. 39.2± 20.7; p=0.858) and MMR (753.6±661.5 vs. 993.3±740.8 Wood units; p=0.174) were similar between groups. TIMI 3 flow was observed in 26.7% vs. 27.0% (p=0.899). Flow-mediated hyperemia showed two different thermodilution patterns during saline infusion indicative of the severity of the no reflow phenomenon. In-hospital death and non-fatal heart failure were observed in 10.4% and 26.9%, respectively. Conclusions: Both treatments showed similar (and limited) efficacy restoring coronary flow. Flow-mediated hyperemia with thermodilution pattern assessment allowed the simultaneous characterization of the no reflow degree and response to hyperemia. No reflow was associated with a high rate of adverse outcomes. Further research is warranted to prevent and to treat no reflow in STEMI patients (NCT04685941).

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“…This indicator is transported with the blood, and the resulting downstream temperature change is detected by a sensor in an intravascular device, such as a catheter or guidewire. The indicator fluid can be injected at a constant rate for a fixed time interval, with a syringe pump (continuous thermodilution) [38][39][40], or in a bolus with a much shorter duration, with a rapid manual injection (instantaneous thermodilution or 'time of flight' thermodilution) [41,42]. In continuous thermodilution, the volumetric blood flow rate is calculated using the known temperature of the indicator fluid at the time of injection and the measured temperature change of the blood [43][44][45].…”

Section: Thermodilutionmentioning

confidence: 99%

Fibre optic intravascular measurements of blood flow: A review

Mackle

Coote

Carr

et al. 2021

Sensors and Actuators A: Physical

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Fibre optic sensors are well suited to measuring fluid flow in many contexts, and recently there has been burgeoning interest in their application to direct, invasive measurement of blood flow within human vasculature. Depending on the sensing method used and assumptions made, these intravascular measurements of blood flow can provide information about local blood velocity, volumetric flow, and flowderived parameters. Fibre optic sensors can be readily integrated into medical devices, which are positioned into arteries and veins to obtain measurements that are inaccessible or cumbersome using non-invasive imaging modalities. Measurements of flow within coronary arteries is a particularly promising application of fibre optic sensing; recent studies have demonstrated the clinical utility of certain flow-based parameters, such as the coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). In this review, research and development of fibre optic flow sensors relevant to intravascular flow measurements are reviewed, with a particular focus on biomedical clinical translation.

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Continuous Thermodilution Method to Assess Coronary Flow Reserve

Cited by 14 publications

References 21 publications

Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now

Invasive Detection of Coronary Microvascular Dysfunction: How It Began, and Where We Are Now

Treatment of Slow-flow After Primary Percutaneous Coronary Intervention With Flow-mediated Hyperemia. The Randomized RAIN-FLOW Study

Fibre optic intravascular measurements of blood flow: A review

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