|Pressure-wire based assessment of microvascular resistance using calibrated upstream balloon obstruction: a predictor of myocardial viability.|
|PMID: 21805603 Owner: NLM Status: MEDLINE|
|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.
|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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|Type: Comparative Study; Journal Article; Research Support, N.I.H., Intramural; Research Support, Non-U.S. Gov't; Validation Studies Date: 2011-10-05|
|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|
|Created Date: 2012-09-21 Completed Date: 2013-02-12 Revised Date: 2014-07-31|
Medline Journal Info:
|Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States|
|Languages: eng Pagination: 581-9 Citation Subset: IM|
|Copyright © 2011 Wiley-Liss, Inc.|
|APA/MLA Format Download EndNote Download BibTex|
Acute Coronary Syndrome
Adenosine / diagnostic use
Angioplasty, Balloon, Coronary* / instrumentation
Cardiac Catheterization* / instrumentation, standards
Fractional Flow Reserve, Myocardial*
Hyperemia / physiopathology
Magnetic Resonance Imaging, Cine
Myocardial Infarction / diagnosis*, pathology, physiopathology, therapy
Myocardium / pathology*
Predictive Value of Tests
Reproducibility of Results
Sensitivity and Specificity
Vasodilator Agents / diagnostic use
|Z01-HL006061-01/HL/NHLBI NIH HHS; ZID HL006061-01/HL/NHLBI NIH HHS|
|0/Vasodilator Agents; K72T3FS567/Adenosine|
|Catheter Cardiovasc Interv. 2012 Oct 1;80(4):590-2
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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