Temporal dissociation between the minimal distal-to-aortic pressure ratio and peak hyperemia during intravenous adenosine infusion

The present study sought to compare the temporal relation between maximal coronary flow (peak hyperemia) and minimal coronary-to-aortic pressure ratio (Pd/Pa) for intracoronary (IC) and intravenous (IV) adenosine administration. Peak hyperemia is assumed to coincide with the minimal Pd/Pa value. However, this has not been confirmed for systemic hemodynamic variations during IV adenosine infusion. Hemodynamic responses to IV and IC adenosine administration were obtained in 12 patients (14 lesions) using combined IC pressure and flow velocity measurements. A fluid dynamic model was used to predict the change in Pd/Pa for different stenosis severities and varying Pa. Hemodynamic variability during IV adenosine hyperemia was greater than during IC adenosine, as assessed by the coefficient of variation. During IV adenosine, flow velocity peaked 28 ± 4 (SE) s after the onset of hyperemia, while Pd/Pa reached a minimum (0.82 ± 0.01) 22 ± 7 s later ( P < 0.05), when Pa had declined by 6.1% and hyperemic velocity by 4.5% ( P < 0.01). Model outcomes corroborated the role of variable Pa in this dissociation. In contrast, maximal flow and minimal Pd/Pa coincided for IC adenosine, with IV-equivalent peak velocities and a higher Pd/Pa ratio (0.86 ± 0.01, P < 0.01). Hemodynamic variability during continuous IV adenosine infusion can lead to temporal dissociation of minimal Pd/Pa and peak hyperemia, in contrast to IC adenosine injection, where maximal velocity and minimal Pd/Pa coincide. Despite this variability, stenosis hemodynamics remained stable with both ways of adenosine administration. Our findings suggest advantages of IC over IV adenosine to identify maximal hyperemia from pressure-only measurements. NEW & NOTEWORTHY Systemic hemodynamic variability during intravenous adenosine infusion produces substantial temporal dissociation between peak hyperemia appraised by coronary flow velocity and the minimal distal-to-aortic pressure ratio commonly used to determine functional stenosis severity. This dissociation was absent for intracoronary adenosine administration and tended to be mitigated in patients receiving Ca2+ antagonists.

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The stability of flow velocity and intracoronary resistance in the intracoronary electrocardiogram-triggered pressure ratio

Scientific Reports ◽

10.1038/s41598-021-93181-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Masafumi Nakayama ◽

Nobuhiro Tanaka ◽

Takashi Uchiyama ◽

Takaaki Ohkawauchi ◽

Yusuke Tsuboko ◽

...

Keyword(s):

Flow Velocity ◽

Coronary Flow ◽

Pressure Ratio ◽

Aortic Pressure ◽

Fractional Flow ◽

Flow Measurements ◽

Flow Reserve ◽

The Stability ◽

Index Value ◽

T Values

AbstractAssessment of coronary artery lesions using the fractional flow reserve and instantaneous flow reserve (iFR) measurements has been found to reduce the incidence of further cardiovascular events. Here, we investigated differences in terms of coronary flow velocity and resistance within the analysis interval between the iFR and the intracoronary electrocardiogram (IC-ECG)-triggered distal/aortic pressure (Pd/Pa) ratio (ICE-T). We enrolled 23 consecutive patients (n = 33 stenoses) who required coronary flow measurements. ICE-T was defined as the average Pd/Pa ratio in the period corresponding to the isoelectric line of the IC-ECG. We compared the index value, flow velocity, and intracoronary resistance during the analysis intervals of the iFR and the ICE-T, both at rest and under hyperemia. ICE-T values and ICE-T intracoronary resistance were both found to be significantly lower, whereas flow velocity was significantly higher than those of the iFR at both rest and under hyperemia (P < 0.001), and all fluctuations in ICE-T values were also significantly smaller than those in the iFR. In conclusion, the ICE-T appears theoretically superior to pressure-dependent indices for analyzing phases with low and stable resistance, without an increase in invasiveness.

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Stability of Flow Velocity and Intracoronary Resistance in the Intracoronary Electrocardiogram-triggered Pressure Ratio

10.21203/rs.3.rs-290000/v1 ◽

2021 ◽

Author(s):

Masafumi Nakayama ◽

Nobuhiro Tanaka ◽

Takashi Uchiyama ◽

Takaaki Ohkawauchi ◽

Yusuke Tsuboko ◽

...

Keyword(s):

Flow Velocity ◽

Coronary Flow ◽

Pressure Ratio ◽

Aortic Pressure ◽

Fractional Flow ◽

Instantaneous Flow ◽

Flow Reserve ◽

Value Flow ◽

Index Value ◽

T Values

Abstract It has been found that the assessment of coronary artery lesions using the fractional flow reserve and instantaneous flow reserve measurements reduces the incidence of further cardiovascular events. Here, we investigated differences in the coronary flow velocity and resistance within the analysis interval between the instantaneous flow reserve (iFR) and the intracoronary electrocardiogram (IC-ECG)-triggered distal/aortic pressure (Pd/Pa) ratio (ICE-T). Thirty-three consecutive patients with stenoses that required coronary flow measurement were enrolled. ICE-T was defined as the average Pd/Pa ratio in the period corresponding to the isoelectric line of the IC-ECG. The index value, flow velocity, and intracoronary resistance during the analysis intervals of the iFR and ICE-T, both at rest and under hyperemia, were compared. The index value and intracoronary resistance of the ICE-T were found to be significantly lower, while the flow velocity was significantly higher, than those of the iFR (P < 0.001), and all fluctuations in ICE-T values were also significantly smaller than those in the iFR.In conclusion, the ICE-T is theoretically superior to pressure-dependent indices for analyzing phases with low and stable resistance, without an increase in invasiveness.

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Prognostic value of non-invasive coronary artery flow velocity assessment in elderly patients

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.097 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

E Kalinina ◽

A Zagatina ◽

N Zhuravskaya ◽

D Shmatov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Elderly Patients ◽

Flow Velocity ◽

Coronary Arteries ◽

Coronary Flow ◽

Prognostic Value ◽

Area Under Curve ◽

Left Coronary Artery ◽

Maximal Velocity

Abstract Funding Acknowledgements Type of funding sources: None. Background There is a high prevalence of coronary artery disease (CAD) in the elderly population. However, symptoms of CAD are often non-specific. Dyspnoe, non-anginal pains are among the main symptoms in older patients. Exercise tests are of limited feasibility in these patients, due to neuro-muscular weakness, physical deconditioning, and orthopaedic limitations. Pharmacological tests often are contraindicated in a substantial percentage of elderly patients. Some recent studies indicate using local flow acceleration during routine echocardiography has prognostic potential for coronary artery assessments without stress testing. The aim of the study was to define the prognostic value of coronary artery ultrasound assessment in patients ≥75 years old. Methods This is a prospective cohort study. Patients ≥ 75 years old who underwent routine echocardiography with additional scans for coronary arteries over a period of 24 months were included in the study. The study group consisted of 80 patients aged 75-90 years (56 women; mean age 79 ± 4). Initial exams were performed for other reasons, primarily for arterial hypertension. Fifteen patients had known CAD. Death, non-fatal myocardial infarction (MI), and revascularization were defined as major adverse cardiac events (MACE). All patients were followed up with at a median of 32 months. Results There were 34 patients with high local velocities in the left coronary artery. Eight deaths, two non-fatal myocardial infarctions occurred, and 13 revascularizations were performed. With a ROC analysis, a coronary flow velocity >110 cm/s was the best predictor for risk of death (area under curve 0.84 [95% CI 0.74–0.92]; sensitivity 75%; specificity 88%). Only the maximal velocity in proximal left-sided coronary arteries was independently associated with death (HR 1.03, 95% CI 1.01; 1.05; p < 0.002), or death/MI (HR 1.03, 95% CI 1.01; 1.04; p < 0.0001). The cut-off value of 66 cm/s was a predictor of all MACE (area under curve 0.87 [95% CI 0.77–0.94]; sensitivity 80%; specificity 86%). Any causes of death or MI occurred more frequently in patients with velocities of >66 cm/s (27% vs. 2%; p < 0.002). The rates of MACE were 58.0% vs. 2%; p < 0.0000001, respectively. Conclusion The analysis of coronary flow in the left coronary artery during echocardiography can be used as a predictor of outcomes in elderly patients. Maximal velocities in proximal left-sided coronary arteries is independently associated with further death or myocardial infarction.

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Is there a correlation between stenosis severity determined by intravascular ultrasound and coronary flow velocity reserve?

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(96)82246-7 ◽

1996 ◽

Vol 27 (2) ◽

pp. 335 ◽

Cited By ~ 4

Author(s):

Dietrich Baumgart ◽

Michael Haude ◽

Fengqi Liu ◽

Junbo Ge ◽

Günter Görge ◽

...

Keyword(s):

Flow Velocity ◽

Intravascular Ultrasound ◽

Coronary Flow ◽

Coronary Flow Velocity Reserve ◽

Coronary Flow Velocity ◽

Stenosis Severity

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P1293 Coronary artery flow velocity alteration by transthoracic echo in a group of young adult males

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.738 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

O Sukhanova ◽

A Zagatina ◽

N Zhuravskaya ◽

A V Ivanov ◽

D Shmatov

Keyword(s):

Cardiovascular Disease ◽

Coronary Artery ◽

High Risk ◽

Ejection Fraction ◽

Flow Velocity ◽

Coronary Flow ◽

Maximal Velocity ◽

Myocardial Mass ◽

Coronary Flow Velocity ◽

Apparently Healthy

Abstract Funding Acknowledgements university Grand Background Atherosclerosis is a chronic and progressive disease that causes high mortality primarily in persons over the age of forty. However, a lot of atherosclerosis cases are only discovered after a fatal cardiovascular event. Several techniques can be used to identify atherosclerosis when it is still in its subclinical stages and at ages before the symptoms of atherosclerosis became marked. The SCORE chart and other scores were developed for this purpose. However, the SCORE chart doesn’t cover the people under 40 years old. A significant portion of patients with a high risk of cardiovascular disease have major cardiac events before reaching 40 years of age. The aim of the study was to define subclinical coronary flow alteration in apparently healthy men between the ages of 30-39. Methods This is part of a study intended to facilitate risk estimation in apparently healthy persons between 30 and 39 years old with no documented cardiovascular disease. Seventy-two consecutive men (34 ± 3 years old) who were assumed healthy, were recruited into the study. A standard cardiology exam; analysis of blood lipids; basic transthoracic echocardiography examination with additional scans of the left main, left anterior descending, and circumflex arteries; and carotid ultrasound were performed. Results Among the study population there were eight obese patients (12.5%), twenty-two (22%) smokers, forty-eight (66%) had dyslipidaemias, and six (8%) had a first-degree relative with known premature coronary or vascular events. All of them had a normal ejection fraction (65 ± 4%) and heart chamber sizes. The mean global longitudinal strain (GLS) was -19.3 ± 2%, myocardial mass index was 77 ± 12 g/m2, and intima-media thickness (IMT) was 0.74 ± 0.19 mm. Intima-media thickening at standard site was found in twelve patients (17%, 95% CI 9-26%), atherosclerosis with pronounced plaques in carotid arteries was diagnosed in twenty-one man (29%, 95% CI 19-40%). The group with atherosclerotic plaques had a higher maximal velocity in coronary arteries (44 ± 16 vs. 33 ± 11 cm/s, p < 0.002) compared to other patients. Ejection fraction (65 ± 5 vs. 65 ± 4 %, p = 0.93), myocardial mass index (81 ± 13 vs. 75 ± 12, g/m2 p = 0.053), and GLS (-19 ± 3 vs. -19 ± 2 %, p = 0.55) were similar. There was a significant correlation between IMT and maximal velocity in coronary arteries (r=-0.44, p < 0.0005). Three patients of atherosclerotic group (14%, 95% CI 3-32%) had coronary flow velocity more than 68 cm/s corresponding significant coronary artery lesions. Conclusion There is a high prevalence of subclinical atherosclerosis among men between the ages of 30 and 39 in a population with a high risk of cardiovascular disease by SCORE chart. Coronary flow velocity assessment could be helpful for detection of coronary lesions in young adult patients with carotid plaques.

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Combining Baseline Distal-to-Aortic Pressure Ratio and Fractional Flow Reserve in the Assessment of Coronary Stenosis Severity

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2015.09.002 ◽

2015 ◽

Vol 8 (13) ◽

pp. 1681-1691 ◽

Cited By ~ 18

Author(s):

Mauro Echavarría-Pinto ◽

Tim P. van de Hoef ◽

Martijn A. van Lavieren ◽

Sukhjinder Nijjer ◽

Borja Ibañez ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Pressure Ratio ◽

Aortic Pressure ◽

Fractional Flow ◽

Flow Reserve ◽

Stenosis Severity

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TCT-300 Combining baseline distal-to-aortic pressure ratio and fractional flow reserve in the assessment of coronary stenosis severity

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.315 ◽

2015 ◽

Vol 66 (15) ◽

pp. B119

Author(s):

Mauro Echavarria-Pinto ◽

Tim P. van de Hoef ◽

Martijn A. van Lavieren ◽

Sukhjinder S. Nijjer ◽

Borja Ibañez ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Coronary Stenosis ◽

Pressure Ratio ◽

Aortic Pressure ◽

Fractional Flow ◽

Flow Reserve ◽

Stenosis Severity

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Transthoracic Coronary Flow Data at Rest Predict High-Risk Stress Tests

Acta Radiologica ◽

10.1177/0284185117733143 ◽

2017 ◽

Vol 59 (6) ◽

pp. 664-671 ◽

Cited By ~ 1

Author(s):

Angela Zagatina ◽

Nadezhda Zhuravskaya ◽

Yuliya Vareldzhyan ◽

Maxim Kamenskikh ◽

Dmitry Shmatov ◽

...

Keyword(s):

Flow Velocity ◽

Coronary Flow ◽

Wall Motion ◽

Maximal Velocity ◽

Exercise Echocardiography ◽

Local Flow ◽

Transthoracic Doppler Echocardiography ◽

Flow Acceleration ◽

Diastolic Velocity ◽

Wall Motion Abnormalities

Background Several recent studies have reported the opportunity to diagnose significant narrowing of the coronary arteries without stress testing using local flow acceleration. Purpose To define how often patients with increased coronary flow velocities at rest (≥ 0.70 m/s) have a positive exercise echocardiography test. Material and Methods A total of 150 patients scheduled for exercise echocardiography were studied using transthoracic Doppler echocardiography in order to assess coronary artery flow velocity before exercise. Pulsed wave Doppler registered blood flow velocity placed on the color signal. The maximal diastolic velocity of coronary flow was measured. Results Of participants, 16% had a velocity of more than 0.70 m/s in the left main/proximal left anterior/proximal left circumflex arteries (LM/pLAD). A significant correlation was observed between the value of the maximal velocity in LM/pLAD and the ejection fraction at the peak of exercise ( r ≈ –0.39, P < 0.0001); between the value of the maximal velocity in LM/pLAD and index of wall motion abnormalities (IWMA) at the peak of exercise ( r ≈ 0.44, P < 0.0001); and between the value of the maximal velocity in LM/pLAD and dIWMA ( r ≈ 0.41, P < 0.0001). Afterwards, severe ischemia in stress echocardiography tests was observed in this group. The average IWMA of these tests was found to be 2.3. Sixty-two angiograms were available for comparison with Doppler data. Conclusion There is a significant correlation between the value of the maximal velocity in LM/pLAD/pLCx at rest and the severity of wall motion abnormalities during exercise tests.

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