Document Detail


Pressure-wire based assessment of microvascular resistance using calibrated upstream balloon obstruction: a predictor of myocardial viability.
MedLine Citation:
PMID:  21805603     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We assess microvascular integrity as a marker of myocardial viability after coronary stenting, using only a pressure guidewire.
BACKGROUND: Microvascular integrity generally is not assessed using pressure-only guidewires because the transducer lies upstream of microvasculature. We partially inflate a balloon inside a coronary stent to achieve a specific normalized pressure drop at rest (distal coronary/aortic pressure = 0.8) and then infuse a vasodilator, to render the wire sensitive to microvascular function. We hypothesize that the further decline in pressure (ΔFFR(0.8) ) predicts MRI myocardial viability.
METHODS: We studied 29 subjects with acute coronary syndrome including myocardial infarction. After successful culprit stenting, the resting coronary/aortic pressure was set to 0.8 using temporary balloon obstruction. ΔFFR(0.8) was defined as 0.8-(distal coronary/aortic pressures) during adenosine-induced hyperemia. The average transmural extent of infarction was defined as the average area of MRI late gadolinium enhancement (after 2.8 ± 1.5 days) divided by the corresponding full thickness of the gadolinium enhanced sector in short axis slices, and was compared with ΔFFR(0.8) . Results: ΔFFR(0.8) corresponded inversely and linearly with the average transmural extent of infarction (r(2) = 0.65, P < 0.001). We found that a transmural extent of infarction of 0.50 corresponded to a ΔFFR(0.8) threshold of 0.1, and had high sensitivity and specificity (100% and 94.4%, respectively).
CONCLUSIONS: Using only an upstream pressure-sensitive guidewire and a partially obstructing balloon during pharmacologic hyperemia, we were able to predict MRI myocardial viability with high accuracy after relief of epicardial stenosis. With further validation, this may prove a useful clinical prognostic tool after percutaneous intervention.
Authors:
June-Hong Kim; Ju-Hyun Park; Kiseok Choo; Sung-Kook Song; Jung-Su Kim; Young-Hyun Park; Jun Kim; Kook-Jin Chun; Dongcheul Han; Anthony Z Faranesh; Robert J Lederman
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't; Validation Studies     Date:  2011-10-05
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  80     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-21     Completed Date:  2013-02-12     Revised Date:  2013-10-17    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  581-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Wiley-Liss, Inc.
Affiliation:
Division of Cardiology, Department of Internal Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / diagnosis*,  pathology,  physiopathology,  therapy
Adenosine / diagnostic use
Aged
Angioplasty, Balloon, Coronary* / instrumentation
Blood Pressure
Calibration
Cardiac Catheterization* / instrumentation,  standards
Cardiac Catheters
Chi-Square Distribution
Female
Fractional Flow Reserve, Myocardial*
Humans
Hyperemia / physiopathology
Linear Models
Magnetic Resonance Imaging, Cine
Male
Microcirculation*
Middle Aged
Multivariate Analysis
Myocardial Infarction / diagnosis*,  pathology,  physiopathology,  therapy
Myocardium / pathology*
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Sensitivity and Specificity
Stents
Tissue Survival
Transducers, Pressure
Treatment Outcome
Vascular Resistance*
Vasodilator Agents / diagnostic use
Grant Support
ID/Acronym/Agency:
Z01-HL006061-01/HL/NHLBI NIH HHS; ZID HL006061-01/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 58-61-7/Adenosine
Comments/Corrections
Comment In:
Catheter Cardiovasc Interv. 2012 Oct 1;80(4):590-2   [PMID:  22996924 ]

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


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