Validation of Doppler FloWire for measurement of coronary flow reserve in humans

Dib, Nabil; Bajwa, Tanvir; Shalev, Yoseph; Nesto, Richard W.; Schmidt, Donald H.

doi:10.1002/(sici)1097-0304(199812)45:4<382::aid-ccd6>3.0.co;2-4

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…It is possible that there were more rapid changes in coronary diameter that we were unable to detect with coronary angiography performed at predetermined time points. The limitations of QCA analyses 33 and the Doppler-tipped guidewire measurements 34 have been described previously.…”

Section: Study Limitationsmentioning

confidence: 99%

Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake

et al. 2005

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Background-Levosimendan is a calcium-sensitizing agent and an inodilator under current investigation in the treatment of decompensated heart failure. The effects of intravenous levosimendan on the human coronary vasculature, together with myocardial wall stress and oxygen uptake, have not been adequately studied. Methods and Results-Ten adult patients underwent right-and left-heart catheterization. Baseline coronary blood flow was determined with quantitative coronary angiography and an intracoronary Doppler-tipped guidewire. Myocardial oxygen uptake was measured with a coronary sinus catheter. Echocardiography was performed before and 30 minutes after an intravenous infusion of levosimendan (24-g/kg bolus over 10 minutes) was begun.

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Section: Study Limitationsmentioning

confidence: 99%

Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake

et al. 2005

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“…It is possible that there were more rapid changes in coronary diameter that we were not able to detect with coronary angiography performed at predetermined time points. The limitations of QCA analyses 10,23 and the Doppler-tipped guidewire measurements 24 have been described previously.…”

Section: Study Limitationsmentioning

confidence: 99%

Effects of Intravenous Nesiritide on Human Coronary Vasomotor Regulation and Myocardial Oxygen Uptake

et al. 2003

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Background-Nesiritide, recombinant human B-type natriuretic peptide, has been shown to be efficacious in the treatment of decompensated heart failure. The effects of intravenous nesiritide on the human coronary vasculature have not been studied. Methods and Results-Ten patients underwent right and left heart catheterization. Baseline coronary blood flow was determined using quantitative coronary angiography (QCA) and an intracoronary Doppler-tipped guidewire. Myocardial oxygen uptake was measured using a coronary sinus catheter. Patients then received an intravenous infusion of nesiritide (2 g/kg bolus followed by 0.01 g/kg per min infusion) for 30 minutes. Right atrial pressure decreased 52% (Pϭ0.012), pulmonary artery mean pressure decreased 19% (Pϭ0.03), pulmonary capillary wedge pressure decreased 46% (Pϭ0.002), and mean arterial pressure decreased 11% (Pϭ0.007). QCA demonstrated a 15% increase in coronary artery diameter from a baseline of 2.6Ϯ0.8 to 3.0Ϯ0.8 mm at 30 minutes (Pϭ0.007). The coronary velocity measure of average peak velocity increased 14% from 20.8Ϯ6.4 at baseline to 23.8Ϯ7.2 cm/s at 5 minutes (Pϭ0.015) and then returned to baseline for the remainder of the infusion. Coronary blood flow increased 35% (Pϭ0.007), whereas coronary resistance decreased 23% at 15 and 30 minutes (Pϭ0.036). Myocardial oxygen uptake decreased 8% during the nesiritide infusion (Pϭ0.043). Conclusions-Nesiritide exerts coronary vasodilator effects on both the coronary conductance and resistance arteries.Despite a decrease in coronary perfusion pressure, coronary artery blood flow is increased, coronary resistance is decreased, and myocardial oxygen uptake is decreased.

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“…Like thermodilution-derived CFR, Doppler-derived CFR also requires preceding administration of nitroglycerine, so that measured change in flow is independent of changes in epicardial vascular volume and solely determined by changes in microvascular tonus. Dib et al 35 validated Doppler-derived CFR in a clinical study, showing a high, significant correlation (r=0.87) in normal and stenotic arteries between CFR measured by Doppler flow wire and by 133 Xe gas clearance, which is a well validated method for assessment of regional myocardial blood flow 36…”

Section: Doppler Guidewirementioning

confidence: 99%

Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI

Amier

Teunissen

Marques

et al. 2013

Heart

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Up to 40% of patients with acute myocardial infarction develop microvascular obstruction (MVO) despite successful treatment with primary percutaneous coronary intervention (PCI). The presence of MVO is linked to negative remodelling and left ventricular dysfunction, leading to decreased long-term survival, increased morbidity and reduced quality of life. The acute obstruction and dysfunction of the microvasculature can potentially be reversed by pharmacological treatment in addition to the standard PCI treatment. Identifying patients with post-PCI occurrence of MVO is essential in assessing which patients could benefit from additional treatment. However, at present there is no validated method to identify these patients. Angiographic parameters like myocardial blush grade or corrected Thrombolysis In Myocardial Infarction (TIMI) flow do not accurately predict the occurrence of MVO as visualised by MRI in the days after the acute event. Theoretically, acute MVO can be detected by intracoronary measurements of flow and resistance directly following the PCI procedure. In MVO the microvasculature is obstructed or destructed and will therefore display a higher coronary microvascular resistance (CMVR). The methods for intracoronary assessment of CMVR are based on either thermodilution or Doppler-flow measurements. The aim of this review is to present an overview of the currently available methods and parameters for assessing CMVR, with special attention given to their use in clinical practice and information provided by clinical studies performed in patients with acute myocardial infarction.

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Validation of Doppler FloWire for measurement of coronary flow reserve in humans

Cited by 10 publications

References 15 publications

Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake

Effects of Intravenous Levosimendan on Human Coronary Vasomotor Regulation, Left Ventricular Wall Stress, and Myocardial Oxygen Uptake

Effects of Intravenous Nesiritide on Human Coronary Vasomotor Regulation and Myocardial Oxygen Uptake

Invasive measurement of coronary microvascular resistance in patients with acute myocardial infarction treated by primary PCI

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