| Importance of diastolic fractional flow reserve and dobutamine challenge in physiologic assessment of myocardial bridging. | |
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MedLine Citation:
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PMID: 12875756 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: This study reports a comparative assessment of the hemodynamic relevance of myocardial bridges (MB) using two modalities of fractional flow reserve (FFR), with and without concomitant inotropic challenge. BACKGROUND: Extravascular coronary compression by means of MB is modulated by myocardial inotropism and causes intracoronary systolic pressure overshooting and negative systolic gradients across the MB. The former characteristic suggests that adequate hemodynamic assessment of MB should include inotropic stimulation. The latter characteristic might interfere with FFR by decreasing the mean pressure gradient. METHODS: We compared the hemodynamic relevance of 12 lone MB in symptomatic patients using conventional (mean) and diastolic FFR. Diastolic FFR was obtained from post-processed, digitally acquired electrocardiogram and pressure signals. Previously validated cut off values of 0.75 (mean FFR) and 0.76 (diastolic FFR) for hemodynamic relevance were used. Measurements were performed at baseline and after incremental intravenous dobutamine doses. RESULTS: Fractional flow reserve decreased during dobutamine challenge: mean FFR was 0.90 +/- 0.04 at baseline and 0.84 +/- 0.06 after dobutamine (p = 0.0008); similarly, diastolic FFR was 0.88 +/- 0.05 and 0.77 +/- 0.10 before and after dobutamine, respectively (p = 0.0006). Diastolic FFR identified hemodynamic relevance in five patients, whereas mean FFR did so in only one patient. The discrepancy between mean FFR and diastolic FFR increased with dobutamine challenge: the ratio of mean FFR/diastolic FFR was 1.03 at baseline and 1.09 after dobutamine (p = 0.02). During the administration of dobutamine, the discrepancy was inversely related to the systolic pressure gradient (r = 0.58, P = 0.04). CONCLUSIONS: Physiologic assessment of MB should include dobutamine challenge. Because the overshooting of systolic pressure interferes with and is a cause of error in FFR measurements based on mean pressures, diastolic FFR appears to be the technique of choice for MB assessment, whereas mean FFR should be used with caution. |
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Authors:
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Javier Escaned; Jorge Cortés; Alex Flores; Javier Goicolea; Fernando Alfonso; Rosana Hernández; Antonio Fernández-Ortiz; Manel Sabaté; Camino Bañuelos; Carlos Macaya |
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Publication Detail:
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Type: Comparative Study; Journal Article; Validation Studies |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 42 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2003 Jul |
Date Detail:
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Created Date: 2003-07-23 Completed Date: 2003-08-20 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 226-33 Citation Subset: AIM; IM |
Affiliation:
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Interventional Cardiology Service, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. jescaned.hcsc@salud.madrid.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adenosine
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diagnostic use Aged Angina Pectoris / etiology Bias (Epidemiology) Blood Flow Velocity* Blood Pressure Cardiotonic Agents / diagnostic use* Coronary Angiography / methods*, standards Coronary Vessel Anomalies / complications, diagnosis*, physiopathology* Diastole* Dobutamine / diagnostic use* Electrocardiography Female Heart Catheterization / methods*, standards Humans Least-Squares Analysis Linear Models Male Middle Aged Patient Selection Predictive Value of Tests Severity of Illness Index Signal Processing, Computer-Assisted Systole Vasodilator Agents / diagnostic use |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 0/Vasodilator Agents; 34368-04-2/Dobutamine; 58-61-7/Adenosine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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