Utilization of translesional hemodynamics: Comparison of pressure and flow methods in stenosis assessment in patients with coronary artery disease

Abstract

Aim of this study is the assessment of feasibility and clinical usefulness of a new index of stenosis severity, the slope of the instantaneous transstenotic pressure gradient/velocity relationship. Twenty‐one patients scheduled for percutaneous revascularization procedures were studied with simultaneous measurement of poststenotic coronary pressure and flow velocity, in basal condition and during maximal hyperemia induced with intracoronary papaverine. Reliable measurements of the transstenotic pressure gradient/velocity relationship could be obtained in 11 patients. In 64% of the cases, a quadratic equation showed the best fit for the data. Steeper increases of the transstenotic pressure gradient at any given velocity increase were observed in the lesions with the smallest cross‐sectional area measured with quantitative angiography. A comparison of this new index with coronary flow reserve, maximal hyperemic velocity, stenosis flow reserve derived from quantitative angiography, basal and hyperemic transstenotic pressure gradient and fractional flow reserve is presented and the relative merits of all these parameters are discussed. This pilot experience suggests that the instantaneous relationship between pressure gradient and flow velocity changes during the cardiac cycle can accurately characterize the stenosis hemodynamics in the catheterization laboratory. © 1996 Wiley‐Liss, Inc.

Advances in three-dimensional coronary imaging and computational fluid dynamics

“…This study also raised a fundamental concern over correlating FFR and CFR values when drawing conclusions about myocardial ischaemia. In contrast to the study by Di Mario et al[58], Meimoun et al[59] showed that four patients with FFR value of 0.80 or less had a CFR value of more than 2.0 and two patients with FFR value of more than 0.80 showed CFR value of 2.0 or less, representing 12% of the patients in this study. A more recent retrospective cohort study[60] with 438 FFR and invasive CFR measurements showed that even though FFR is correlated to CFR (r = 0.34; P < 0.001), almost 40% of lesions show discordance between FFR and CFR.Johnson et al[60] demonstrated that neither invasive nor noninvasive CFR measurement techniques can be attributed to the discordance of FFR and CFR.…”

“…Di Mario et al[58] studied 21 patients, reporting r = 0.58 (P < 0.01), demonstrating a weak correlation between FFR and invasive CFR. In addition, their study showed that patients with an FFR value of 0.75 or less usually have a CFR value of 2.0 or less.…”

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

“…Fifteen years later, the first ⌬P-v relationships of coronary stenoses in humans were obtained after placement of both a pressure and Doppler guidewire distal to the lesion. 11,12 Marques and coworkers 13 demonstrated the feasibility and reproducibility of this diastolic relationship and its ability to discriminate between normal and diseased coronary arteries.…”

“…9,10 Diastolic pressure gradient-velocity (⌬P-v) relationships have been obtained in humans with 2 single-sensor-equipped guidewires. [11][12][13] Recently, the simultaneous measurement of phasic distal pressure and velocity by a single dual-sensor-equipped guidewire has become possible.…”

Correlation of Hemodynamic Events with Clinical and Pathological Observations

“…6,20,30 This can be accomplished with a single wire equipped with two sensors, thanks to recent developments in wire technology. 31 These combined data allow the separate assessment of coronary stenosis and microvascular resistance, which has been successfully applied to develop improved concepts for diagnosis of coronary artery disease and evaluation of percutaneous interventions.…”