Single-Wire Pressure and Flow Velocity Measurement to Quantify Coronary Stenosis Hemodynamics and Effects of Percutaneous Interventions

Siebes, Maria; Verhoeff, Bart-Jan; Meuwissen, Martijn; Winter, Robbert J. de; Spaan, Jos A. E.; Piek, Jan J.

doi:10.1161/01.cir.0000112571.06979.b2

Cited by 165 publications

(141 citation statements)

References 38 publications

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“…For evaluation of the functional severity of coronary stenoses in the clinic (5,20,25), adenosineinduced coronary hyperemia is taken as index for the maximal obtainable conductance induced by increased cardiac work or an ischemic stimulus. In the present study in dog hearts, maximal conductance during peak RH was found to be ϳ25% lower than that obtained during adenosine and the difference was almost gone after treatment of the glycocalyx.…”

Section: Rh Vs Ahmentioning

confidence: 99%

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

VanTeeffelen

Dekker

Fokkema

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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. Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts. Am J Physiol Heart Circ Physiol 289: H2508 -H2513, 2005. First published July 22, 2005; doi:10.1152/ajpheart.00446.2005.-Because adenosine is commonly used for inducing maximal coronary hyperemia in the clinic, it is imperative that adenosine-induced hyperemia (AH) resembles coronary hyperemia that can be attained by endogenous stimuli. In the present study we hypothesized that coronary reactive hyperemia (RH) is limited compared with AH due to the presence of the glycocalyx and that the AH response is therefore unable to detect glycocalyx modifications. In anesthetized open-chest dogs, blood flow and pressure were measured in the left circumflex artery. RH after 15-s occlusion was compared with an intracoronary infusion of adenosine (650 g; AH) during control conditions and after intracoronary treatment of the glycocalyx with hyaluronidase (20.000 U, 2 ϫ 20 min; n ϭ 6) or heat-inactivated hyaluronidase (n ϭ 5). During control, coronary conductance during RH was 1.49 Ϯ 0.15 ml ⅐ mmHg Ϫ1 ⅐ min Ϫ1 and 76 Ϯ 7% of coronary conductance during AH (P Ͻ 0.05). After hyaluronidase, RH conductance increased (P Ͻ 0.01) by 43 Ϯ 13% and became 93 Ϯ 4% of AH conductance (P ϭ NS). Heatinactivated hyaluronidase had no effect on RH and AH conductance. Our results demonstrate that adenosine-induced coronary hyperemia profoundly exceeds RH and that the difference is virtually abolished on selective removal of the glycocalyx. It is concluded that, compared with RH, adenosine-induced coronary hyperemia is not affected by modification of the glycocalyx. This glycocalyx insensitivity should be taken into account when using adenosine-induced coronary hyperemia as a marker for vasodilating capacity to an ischemic stimulus. coronary circulation; hyaluronidase; dogs TO ASSESS the functional severity of coronary stenoses in the clinic, use of adenosine for inducing maximal coronary hyperemia in patients has been well established (8,10,17,34). Clinical decision-making to intervene is based on intracoronary parameters that are derived during hyperemia, and it is therefore critical that the adenosine-induced hyperemia accurately reflects the coronary hyperemia that can be attained by endogenous stimuli (7). Intravital microscopic studies of cremaster tissue have suggested that adenosine affects capillary perfusion by limiting the effect of the glycocalyx on vascular resistance (3,12,21). The glycocalyx is the carbohydrate-rich matrix that lines the luminal surface of blood vessels and forms the true interface between the endothelium and flowing blood (6,24,26,30). Normally, flowing red blood cells and large dextrans are excluded from the glycocalyx in cremaster capillaries (6, 30, 31). However, it was shown that adenosine superfusion impaired glycocalyx exclusion properties (21). Because an intact glycocalyx strongly reduces the volume available for flow of plasma and red blood cells in capillaries (3,22,30), an impaired g...

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Section: Rh Vs Ahmentioning

confidence: 99%

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

VanTeeffelen

Dekker

Fokkema

et al. 2005

American Journal of Physiology-Heart and Circulatory Physiology

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“…11,12 The Doppler sensor-mounted wire (ComboWire; Volcano Corporation, Rancho Cordova, California) has been validated in coronary stenosis evaluation during cardiovascular interventions. 13 Measurements with the ComboWire can be performed during the endovascular treatment of intracranial aneurysms, even in patients with ruptured aneurysms. 12 In these acutely ill patients, PC-MR imaging measurements are usually not feasible.…”

mentioning

confidence: 99%

Comparison of Phase-Contrast MR Imaging and Endovascular Sonography for Intracranial Blood Flow Velocity Measurements

Schneiders¹,

Ferns²,

Ooij³

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Local hemodynamic information may help to stratify rupture risk of cerebral aneurysms. Patient-specific modeling of cerebral hemodynamics requires accurate data on BFV in perianeurysmal arteries as boundary conditions for CFD. The aim was to compare the BFV measured with PC-MR imaging with that obtained by using intra-arterial Doppler sonography and to determine interpatient variation in intracranial BFV.

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“…Second, MR appears to be independent of epicardial artery disease. Previous reports (3,30,33) have documented an increase in MR in the presence of an epicardial artery stenosis. From the present study's results, even in the presence of a moderate epicardial stenosis, the increase of NMR could still be used to evaluate the microvascular disruption.…”

Section: H404 Assessment Of Coronary Microcirculation In a Swine Modelmentioning

confidence: 87%

Assessment of coronary microcirculation in a swine animal model

Zhang

Takarada

Molloi

2011

American Journal of Physiology-Heart and Circulatory Physiology

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Coronary microvascular dysfunction has important prognostic implications. Several hemodynamic indexes, such as coronary flow reserve (CFR), microvascular resistance, and zero-flow pressure (Pzf), were used to establish the most reliable index to assess coronary microcirculation. Fifteen swine were instrumented with a flow probe, and a pressure wire was advanced into the distal left anterior descending artery. Adenosine was used to produce maximum hyperemia. Microspheres were used to create microvascular dysfunction. An occluder was used to produce stenosis. Blood flow from the probe (Q p), aortic pressure, distal coronary pressure, and right atrium pressure were recorded. Angiographic flow (Q a) was calculated using a time-density curve. Flow probe-based CFR and angiographic CFR were calculated using Q p and Q a, respectively. Flow probe-based (NMRqh) and angiographic normalized microvascular resistance (NMRah) were determined using Q p and Q a, respectively, during hyperemia. Pzf was calculated using Q p and distal coronary pressure. Two series of receiver operating characteristic curves were generated: normal epicardial artery model (N model) and stenosis model (S model). The areas under the receiver operating characteristic curves for flow probe-based CFR, angiographic CFR, NMRqh, NMRah, and Pzf were 0. 855, 0.836, 0.976, 0.956, and 0.855 in N model and 0.737, 0.700, 0.935, 0.889, and 0.698 in S model. Both NMRqh and NMRah were significantly more reliable than CFR and Pzf in detecting the microvascular deterioration. Compared with CFR and Pzf, NMR provided a more accurate assessment of microcirculation. This improved accuracy was more prevalent when stenosis existed. Moreover, NMRah is potentially a less invasive method for assessing coronary microcirculation.angiography; blood flow; cardiovascular imaging; coronary microvascular function CORONARY ANGIOGRAPHY, a routine examination for patients with heart disease, provides an assessment of stenosis severity by visualizing the opacified arterial lumen. However, in many cases (12,40), the severity of myocardium ischemia correlates poorly with epicardial stenosis. Therefore, intracoronary physiological techniques have been developed to provide physiological evaluations for patients who undergo coronary angiography (8,34). Recently, the medical community's interest in coronary microcirculation has grown with the increasing awareness that microvascular dysfunction occurs in a number of myocardial disease states and has important prognostic implications (19,20). With this recognition comes the need for a method to accurately assess the functional capacity of coronary microcirculation for diagnostic purposes and to monitor the effects of therapeutic interventions targeted at reversing the extent of coronary microvascular dysfunction. To assess changes in the microcirculatory bed, several indexes have been proposed, such as coronary flow reserve (CFR), microvascular resistance (MR), and zero-flow pressure (P zf ). In the early 1990s, Gould et al. (14) introduced CFR...

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Single-Wire Pressure and Flow Velocity Measurement to Quantify Coronary Stenosis Hemodynamics and Effects of Percutaneous Interventions

Cited by 165 publications

References 38 publications

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

Hyaluronidase treatment of coronary glycocalyx increases reactive hyperemia but not adenosine hyperemia in dog hearts

Comparison of Phase-Contrast MR Imaging and Endovascular Sonography for Intracranial Blood Flow Velocity Measurements

Assessment of coronary microcirculation in a swine animal model

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