Coronary Flow Velocity Reserve After Percutaneous Interventions Is Predictive of Periprocedural Outcome

Abstract

Background-Because heterogeneous results have been reported, we assessed coronary flow velocity changes in individuals who underwent percutaneous transluminal coronary angioplasty (PTCA) and examined their impact on clinical outcome. Methods and Results-As part of the Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II study, 379 patients underwent Doppler flow-guided angioplasty. All patients were evaluated according to their coronary flow velocity reserve (CFVR) results (Ն2.5 or Ͻ2.5) at the end of the procedure. A CFVR Ͻ2.5 after angioplasty was associated with an elevated baseline blood flow velocity in both the target artery and reference artery. CFVR before PTCA and CFVR in the reference artery were independent predictors of an optimal CFVR after balloon angioplasty (CFVR

Impact of Coronary Plaque Burden and Composition on Periprocedural Myocardial Infarction and Coronary Flow Reserve After Percutaneous Coronary Intervention

“…12) Furthermore, coronary microembolization during PCI can cause a significant reduction in CFR, and the CFR reduction can predict worse outcomes. [11][12][13][14] Because PMI occurs more frequently with PCI in patients with unstable angina pectoris, 1) plaque composition may contribute to the high probability of distal embolization. Radiofrequency-derived histopathological analysis by intravascular ultrasound (IVUS) has demonstrated that large necrotic cores are related to distal embolization and post-PCI cTn elevation.…”

Relationship Between Functional Exercise Capacity and Functional Stenosis in Patients With Stable Angina and Intermediate Coronary Stenosis

“…1 Thus, a reduction in coronary flow reserve apparently reflects both epicardial and microvascular disease. 16,17 Other studies have shown that exercise training improves endothelium-dependent vasodilatation in both epicardial coronary vessels and resistance vessels in patients with coronary artery disease. 2 Exercise brings about a change in the relationship between myocardial blood flow and coronary pressure in patients with moderate stenosis; the linear relationship between perfusion pressure and blood flow at exercise in cases of a moderate stenosis of the epicardial artery shifted upward and were closer to those found with hyperemia than those for the subendocardial artery.…”

Pathophysiological aspects and management workflow of coronary microvascular obstruction in ST-segment elevation myocardial infarction

“…Recently, a pre-existing impairment of the myocardial microcirculation, principally due to cardiovascular risk factors, has been shown to yield greater vulnerability to PCIrelated myocardial injury as well as a poor long-term outcome. 5,6 In particular, a pre-existing transient or permanent microcirculatory dysfunction may con-N o n -c o m m e r c i a l u s e o n l y tribute to the development and prognosis of acute coronary syndrome (ACS) via reduction of coronary blood flow, leading to an alteration of shear stress and thereby worsening of endothelial function at epicardial level as well as aggravation of thrombus formation. 7 Ischemic and reperfusion related injuries have been translated to humans from the animal models with a first description by Kloner et al 8 In particular, electron microscopic analysis after 90-min coronary occlusion followed by reperfusion, revealed severe capillary damage, endothelial protrusions and blebs blocking the capillary lumen, and endothelial gaps with extra vascular erythrocytes.…”