Influence of Percutaneous Coronary Intervention on Coronary Microvascular Resistance Index

Verhoeff, Bart-Jan; Siebes, Maria; Meuwissen, Martijn; Atasever, Bektaş; Voskuil, Michiel; Winter, Robbert J. de; Koch, Karel T.; Tijssen, Jan G.P.; Spaan, Jos A. E.; Piek, Jan J.

doi:10.1161/01.cir.0000151610.98409.2f

Cited by 110 publications

(112 citation statements)

References 44 publications

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“…In these territories, a possible coronary flow increase after PCI might be limited by responsive microvascular resistance increases. Currently, controversy exists about whether hyperemic microvascular resistance in the presence of functionally significant stenosis is equivalent to that after stenosis removal by PCI 9, 10, 26, 27, 28. Our results clearly demonstrated that microvascular resistance was affected by PCI, and its direction of change had an impact on CFR change and hyperemic coronary flow after successful PCI.…”

Section: Discussionmentioning

confidence: 50%

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Matsuda

Murai

Kanaji

et al. 2016

JAHA

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BackgroundFractional flow reserve (FFR) and coronary flow reserve (CFR) are well‐validated physiological indices; however, changes in FFR and CFR after percutaneous coronary intervention (PCI) remain elusive. We sought to evaluate these changes and to investigate whether physiological indices predict cardiac event‐free survival after PCI.Methods and ResultsPhysiological assessment of 220 stenoses from 220 patients was performed before and after PCI. The changes in FFR and CFR were studied, and factors associated with CFR change were investigated. Follow‐up data were collected to determine the predictor of cardiac events. CFR increase was found in 158 (71.8%) territories, and 62 (28.2%) presented a decrease, whereas FFR increased in all 220 (100%) territories. Pre‐ and post‐PCI percentage diameter stenoses were 57.7±11.2% and 7.48±4.79%, respectively. Post‐PCI CFR increase was associated with pre‐PCI indices including low FFR, low CFR and high microvascular resistance, and post‐PCI hyperemic coronary flow increase. Post‐PCI CFR decrease was not associated with significant post‐PCI hyperemic coronary flow increase. At a median follow‐up of 24.3 months, adverse event–free survival was significantly worse in patients with lower pre‐PCI CFR (log‐rank test λ2=7.26; P=0.007). Cox proportional hazards analysis showed that lower pre‐PCI CFR (hazard ratio 0.73; 95% CI 0.55–0.97; P=0.028) was an independent predictor of adverse cardiovascular events after PCI.Conclusions CFR decrease after PCI was not uncommon, and discordant change in FFR and CFR was associated with high pre‐PCI CFR, low pre‐PCI microvascular resistance, and no significant post‐PCI hyperemic coronary flow increase. Pre‐PCI CFR, not post‐PCI physiological indices, may help identify patients who require adjunctive management strategy after successful PCI.

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Section: Discussionmentioning

confidence: 50%

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Matsuda

Murai

Kanaji

et al. 2016

JAHA

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“…It has been proposed that the presence of microvascular dysfunction is not an obstacle for making decisions based on FFR, provided that minimal and constant microvascular resistance with induced hyperemia is deemed to be nonreversible or consistent before and after revascularization 28, 29. However, several studies reported the evidence of serial changes in adenosine‐induced microvascular resistance before, after, and during follow‐up post‐PCI 13, 30, 31. van de Hoef et al also reported that identification of epicardial disease severity by FFR is partly obscured by microvascular resistance and that FFR increased with increasing hyperemic microvascular resistance to epicardial disease of equivalent severity 15.…”

Section: Discussionmentioning

confidence: 99%

Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

Yonetsu

Murai

Kanaji

et al. 2017

JAHA

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BackgroundDespite a moderate correlation between angiographical stenosis and physiological significance, the mechanism of discordance has not been fully elucidated, particularly regarding the significance of microvascular function. This study sought to clarify whether microvascular function affects visual‐functional mismatch between quantitative coronary angiography (QCA) and fractional flow reserve (FFR).Methods and ResultsWe assessed QCA, FFR, coronary flow reserve, and the index of microcirculatory resistance in 849 non‐left‐main coronary lesions with visually estimated intermediate stenoses from 532 patients. Clinical and lesion‐specific characteristics and physiological parameters associated with mismatch and reverse mismatch were studied. Coronary flow reserve and index of microcirculatory resistance showed a weak, but significant, correlation with FFR (R=0.306, P<0.001 and R=0.158, P<0.001, respectively). Four hundred twenty‐two lesions were visually nonsignificant (diameter stenosis assessed by QCA [QCA‐DS] ≤50%) and 427 lesions were visually significant (QCA‐DS >50%). Among visually nonsignificant lesions, FFR ≤0.80 (reverse mismatch) was observed in 129 lesions (30.6%). Among visually significant lesions, FFR >0.80 (mismatch) were observed in 179 lesions (41.9%). The significant predictors of reverse mismatch were male sex, nonculprit lesions of acute coronary syndrome, left anterior descending artery location, smaller QCA reference diameter, greater QCA‐DS, lower coronary flow reserve, and lower index of microcirculatory resistance. Mismatch was associated with right coronary artery location, greater QCA reference diameter, smaller QCA‐DS, lesion length, higher coronary flow reserve, and higher index of microcirculatory resistance.ConclusionsThere was a high prevalence of visual‐functional mismatches between QCA and FFR. The discrepancy was related to clinical characteristics, lesion‐specific factors, and microvascular resistance that was undistinguishable by coronary angiography, thus suggesting the importance of physiological lesion assessment.

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“…A 0.014-in. dual-sensor guide wire (Volcano, Rancho Cordova, CA) with a Doppler sensor at the tip and a pressure sensor 3 cm proximal to the tip was advanced to a distal location in the interrogated coronary vessel to record intracoronary perfusion pressure (P d) and flow velocity (U) signals (20,25). Care was taken to place both sensors in a smooth vessel segment and to obtain an optimal and stable velocity signal according to recommended techniques for sensor-wire measurements (6).…”

Section: Methodsmentioning

confidence: 99%

Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique

Kolyva¹,

Spaan²,

Piek³

et al. 2008

American Journal of Physiology-Heart and Circulatory Physiology

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Kolyva C, Spaan JA, Piek JJ, Siebes M. Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique. Am J Physiol Heart Circ Physiol 295: H482-H490, 2008. First published May 30, 2008 doi:10.1152/ajpheart.00223.2008.-A novel single-point technique to calculate local arterial wave speed (SPc) has recently been presented and applied in healthy human coronary arteries at baseline flow. We investigated its applicability for conditions commonly encountered in the catheterization laboratory. Intracoronary pressure (Pd) and Doppler velocity (U) were recorded in 29 patients at rest and during adenosine-induced hyperemia in a distal segment of a normal reference vessel and downstream of a single stenosis before and after revascularization. Conduit vessel tone was minimized with nitroglycerin. Microvascular resistance (MR) and SPc were calculated from Pd and U. In the reference vessel, SPc decreased from 21.5 m/s (SD 8.0) to 10.5 m/s (SD 4.1) after microvascular dilation (P Ͻ 0.0001). SPc was substantially higher in the presence of a proximal stenosis and decreased from 34.4 m/s (SD 18.2) at rest to 27.5 m/s (SD 13.4) during hyperemia (P Ͻ 0.0001), with a concomitant reduction in Pd by 20 mmHg and MR by 55.4%. The stent placement further reduced hyperemic MR by 26% and increased Pd by 26 mmHg but paradoxically decreased SPc to 13.1 m/s (SD 7.7) (P Ͻ 0.0001). Changes in SPc correlated strongly with changes in MR (P Ͻ 0.001) but were inversely related to changes in Pd (P Ͻ 0.01). In conclusion, the single-point method yielded erroneous predictions of changes in coronary wave speed induced by a proximal stenosis and distal vasodilation and is therefore not appropriate for estimating local wave speed in coronary vessels. Our findings are well described by a lumped reservoir model reflecting the "windkesselness" of the coronary arteries. coronary hemodynamics; pulse wave velocity; microvascular resistance; intramyocardial pump; stenosis ARTERIAL PULSE WAVE VELOCITY is directly related to the elastic properties of the vessel wall by the well-known MoensKorteweg equation (14) and represents an important marker of vascular pathology associated with the risk of cardiovascular events (2,17,27). Consequently, wave speed is influenced by factors that affect wall stiffness, such as age, vascular disease, distending pressure, and vascular tone (2,11,13,15,23). It is also a fundamental parameter required in wave intensity analysis for the separation of traveling waves into their forward and backward components (4,8,16).The average wave speed along a vessel segment with fairly uniform wall properties can be determined with the standard foot-to-foot method from the pulse delay between two measurement locations (1, 14). Local wave speed based on simultaneous pressure and velocity measurements at a single location can be obtained by the pressure-velocity loop method (7, 8), but it requires unidirectional waves during at least part of the cycle. Neither method is suitable for the coronary cir...

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Influence of Percutaneous Coronary Intervention on Coronary Microvascular Resistance Index

Cited by 110 publications

References 44 publications

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Prevalence and Clinical Significance of Discordant Changes in Fractional and Coronary Flow Reserve After Elective Percutaneous Coronary Intervention

Significance of Microvascular Function in Visual—Functional Mismatch Between Invasive Coronary Angiography and Fractional Flow Reserve

Windkesselness of coronary arteries hampers assessment of human coronary wave speed by single-point technique

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