Document Detail


Coronary pressure notch: an early non-hyperemic visual indicator of the physiologic significance of a coronary artery stenosis.
MedLine Citation:
PMID:  15550728     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The disappearance of a dichrotic notch on the peripheral arterial pulse wave has been associated with significant peripheral vascular disease. A similar observation has not been reported in the distal coronary pressure waveform. The purpose of this study was to investigate the significance of a coronary pressure notch distal to a coronary stenosis and its relationship to fractional flow reserve. Ninety-seven patients with 131 angiographically indeterminate lesions (40-80% diameter narrowing) underwent FFR measurements for physiological significance. Hemodynamic tracings were recorded prior to the administration of adenosine and visually analyzed for the presence or absence of a dicrotic notch in the distal coronary artery pressure tracing. The stenoses were then divided into two groups based on the presence or absence of a notch. Of the 54 lesions without a distal coronary pressure notch, 31 had a FFR greater than or equal to 0.75 and of the 77 lesions with a notch, 75 had a FFR greater than or equal to 0.76. The sensitivity and specificity of a pressure notch was 94% and 74%, respectively, with positive and negative predictive values of 57% and 97%, respectively. The presence of a distal coronary pressure notch was predictive of a FFR greater than or equal to 0.76. The distal dicrotic pressure notch may be used as an additional parameter without requiring hyperemia for FFR measurements of uncertain clinical significance.
Authors:
David Holmes; Priya Velappan; Morton J Kern
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Journal of invasive cardiology     Volume:  16     ISSN:  1042-3931     ISO Abbreviation:  J Invasive Cardiol     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-11-19     Completed Date:  2005-01-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8917477     Medline TA:  J Invasive Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  617-20     Citation Subset:  IM    
Affiliation:
J.G. Mudd Cardiac Catheterization Lab, St. Louis University Hospital, 3635 Vista Avenue at Grand Blvd., Saint Louis, MO 63110, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged
Blood Flow Velocity / physiology
Cohort Studies
Coronary Angiography / methods*
Coronary Circulation / physiology*
Coronary Stenosis / physiopathology,  radiography*
Female
Hemodynamics / physiology
Humans
Hyperemia / radiography
Male
Middle Aged
Predictive Value of Tests
Pressure
Prognosis
Prospective Studies
Pulse
ROC Curve
Risk Assessment
Sensitivity and Specificity
Severity of Illness Index
Sex Factors
Vascular Resistance / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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