| Reliability of fractional flow reserve measurements in patients with associated microvascular dysfunction: importance of flow on translesional pressure gradient. | |
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MedLine Citation:
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PMID: 11747174 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Fractional flow reserve (FFR) has been applied with success as a lesion-specific functional indicator of stenosis severity, at least in patients with normal microcirculation. This study sought to assess the reliability of FFR calculations in patients with associated microvascular dysfunction (e.g., post myocardial infarction, or post-MI). First, the effect of coronary flow changes on translesional pressure gradient was assessed. Therefore, intracoronary pressure and flow was recorded simultaneously across 19 non-infarct-related lesions (both pre- and postinterventional lesions with a mean diameter stenosis of 47% +/- 12%). Measurements were performed by means of a pressure and Doppler wire during maximal hyperemia and also during submaximal hyperemia induced by low-dose adenosine. The drop of coronary flow from 48 +/- 23 ml/min during maximal hyperemia to 36 +/- 18 ml/min during submaximal hyperemia was associated with a small decrease in translesional pressure gradient (from 22 +/- 12 mm Hg to 19 +/- 12 mm Hg; P = 0.02) and a small increase in the mean distal/arterial pressure ratio (Pd/Pa) going from 77% +/- 11% to 81% +/- 11% (P = 0.003). Then, intracoronary pressure and flow measurements were compared across 21 non-infarct-related lesions vs. 22 matched infarct-related lesions. For a similar angiographic stenosis severity (% DS = +/- 44%), maximal flow was 48 +/- 22 ml/min in the non-infarct arteries and 37 +/- 26 ml/min in the infarct arteries (P = 0.03), confirming the presence of severe microvascular dysfunction in infarct regions. Similar to the earlier findings, this hyperemic flow reduction in MI patients was associated with a small increase of FFR (= Pd/Pa): 79% +/- 12% in no MI vs. 83% +/- 12% in MI patients (P = 0.3). A reduction of hyperemic flow by +25%, [correction] such as can be found in patients with severely impaired microvascular function, has a limited effect on FFR calculations (+ 5%). This finding allows the application of standard FFR calculations in a more general population of ischemic heart disease, including patients with recent MI. |
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Authors:
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M J Claeys; J M Bosmans; J Hendrix; C J Vrints |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions Volume: 54 ISSN: 1522-1946 ISO Abbreviation: Catheter Cardiovasc Interv Publication Date: 2001 Dec |
Date Detail:
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Created Date: 2001-12-17 Completed Date: 2002-01-16 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 100884139 Medline TA: Catheter Cardiovasc Interv Country: United States |
Other Details:
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Languages: eng Pagination: 427-34 Citation Subset: IM |
Copyright Information:
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Copyright 2001 Wiley-Liss, Inc. |
Affiliation:
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Department of Cardiology, University Hospital Antwerp, University of Antwerp, Antwerp, Belgium. mclaeys@uia.ua.ac.be |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Blood Flow Velocity / physiology* Blood Pressure / physiology Coronary Angiography Coronary Circulation / physiology Coronary Stenosis / complications, physiopathology Humans Hyperemia / complications, physiopathology Male Middle Aged Myocardial Infarction / complications, physiopathology Reproducibility of Results Severity of Illness Index Ventricular Dysfunction / complications*, physiopathology* |
| Comments/Corrections | |
Comment In:
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Catheter Cardiovasc Interv. 2001 Dec;54(4):435-6
[PMID:
11747175
]
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Erratum In:
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Catheter Cardiovasc Interv 2002 Apr;55(4):531 |
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