Coronary physiological assessment in the catheter laboratory: haemodynamics, clinical assessment and future perspectives

Morris, Paul D; Al‐Lamee, Rasha; Berry, Colin

doi:10.1136/heartjnl-2020-318743

Cited by 10 publications

(2 citation statements)

References 39 publications

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“…Flow velocity measured from the left ventricular outflow tract is similar between the sexes [55]. Coronary artery haemodynamics can be measured in several ways including blood flow, coronary flow reserve, index of microcirculatory resistance and fractional flow reserve [56,57]. Coronary artery blood flow is greatest during diastole, and wave intensity analysis has shown this is primarily driven by a backward travelling 'suction' wave generated distally [58].…”

Section: Pressure and Flow Waveform Physiologymentioning

confidence: 99%

Sex differences in pressure and flow waveform physiology across the life course

Picone

Kodithuwakku

Mayer

et al. 2022

Journal of Hypertension

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Cardiovascular disease (CVD) has long been deemed a disease of old men. However, in 2019 CVD accounted for 35% of all deaths in women and, therefore, remains the leading cause of death in both men and women. There is increasing evidence to show that risk factors, pathophysiology and health outcomes related to CVD differ in women compared with men, yet CVD in women remains understudied, underdiagnosed and undertreated. Differences exist between the sexes in relation to the structure of the heart and vasculature, which translate into differences in blood pressure and flow waveform physiology. These physiological differences between women and men may represent an important explanatory factor contributing to the sex disparity in CVD presentation and outcomes but remain understudied. In this review we aim to describe sex differences in arterial pressure and flow waveform physiology and explore how they may contribute to differences in CVD in women compared to men. Given that unfavourable alterations in the cardiovascular structure and function can start as early as in utero, we report sex differences in waveform physiology across the entire life course.

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Section: Pressure and Flow Waveform Physiologymentioning

confidence: 99%

Sex differences in pressure and flow waveform physiology across the life course

Picone

Kodithuwakku

Mayer

et al. 2022

Journal of Hypertension

View full text Add to dashboard Cite

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“…Unlike epicardial disease, the investigation and treatment of coronary microvascular dysfunction (CMD) is less well established. In many cases, CMD is associated with increased coronary microvascular resistance (CMVR) ( 1 ). CMD is common in patients with epicardial coronary artery disease (CAD) and in those with angina with no obstructive epicardial disease (ANOCA) ( 2 ), with a recent meta-analysis suggesting a prevalence of 41% in the latter group ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Sex differences in coronary microvascular resistance measured by a computational fluid dynamics model

Taylor

Aubiniere-Robb

Gosling

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIncreased coronary microvascular resistance (CMVR) is associated with coronary microvascular dysfunction (CMD). Although CMD is more common in women, sex-specific differences in CMVR have not been demonstrated previously.AimTo compare CMVR between men and women being investigated for chest pain.Methods and resultsWe used a computational fluid dynamics (CFD) model of human coronary physiology to calculate absolute CMVR based on invasive coronary angiographic images and pressures in 203 coronary arteries from 144 individual patients. CMVR was significantly higher in women than men (860 [650–1,205] vs. 680 [520–865] WU, Z = −2.24, p = 0.025). None of the other major subgroup comparisons yielded any differences in CMVR.ConclusionCMVR was significantly higher in women compared with men. These sex-specific differences may help to explain the increased prevalence of CMD in women.

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Effect of Guiding Catheter Extubation During Physiological Assesment of Stenosis

Karim,

Westra,

Rasmussen

et al. 2024

Cathet Cardio Intervent

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BackgroundExtubation of the coronary guiding catheter may affect flow and pressure measurements in the coronary vessel during invasive coronary angiography (ICA).AimThis study aims to investigate the impact of guiding catheter extubation on fractional flow reserve (FFR), coronary flow reserve (CFR), and the index of microcirculatory resistance (IMR).MethodsThis predefined subgroup analysis of the Dan‐NICAD 2 study included patients with chronic coronary syndrome referred to ICA based on a coronary computed tomography angiography. Thermodilution was performed in all vessels evaluated with 30%–90% diameter stenosis on a visual estimate. The primary endpoints were FFR, CFR, and IMR changes when the guiding catheter was extubated from the coronary ostium. Three‐dimensional quantitative coronary angiography analysis was conducted to evaluate whether the proximal flow area, defined as the area of the guiding catheter subtracted from the area of the vessel ostium, correlated with the changes in FFR, CFR, and IMR.ResultsIn 84 patients, coronary physiological measurements were performed twice: once with the guiding catheter intubated and once extubated. FFR decreased during guiding catheter extubation (0.82 ± 0.09 vs. 0.80 ± 0.10) with a mean difference of 0.02, 95% CI [0.01–0.03], p < 0.001. Following extubation, eight patients (8.7%) showed FFR values shifting from > 0.80 to ≤ 0.80. IMR increased during guiding catheter extubation (16.8 ± 8.50 vs. 21.4 ± 16.1) with mean difference of 4.67 [95% CI 1.74–7.60], p = 0.002. No significant changes in CFR were observed; intubated 3.09 ± 1.31 vs 2.84 ± 1.30; difference mean 0.25, [95% CI −0.07 to 0.56], p = 0.12. No significant correlations were found between the proximal flow area and the difference in FFR, CFR, and IMR from intubated to extubated: (r −0.14, p = 0.23), (r −0.11, p = 0.34), and (r −0.16, p = 0.17), respectively.ConclusionExtubating the guiding catheter decreased FFR and increased IMR. This resulted in an FFR decrease from > 0.80 to ≤ 0.80 in 8.7% of patients. CFR remained unchanged. No significant correlation was found between FFR/IMR changes and proximal flow area.

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Coronary physiological assessment in the catheter laboratory: haemodynamics, clinical assessment and future perspectives

Cited by 10 publications

References 39 publications

Sex differences in pressure and flow waveform physiology across the life course

Sex differences in pressure and flow waveform physiology across the life course

Sex differences in coronary microvascular resistance measured by a computational fluid dynamics model

Effect of Guiding Catheter Extubation During Physiological Assesment of Stenosis

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