Relationship between coronary flow velocity reserve and aortic stiffness

2006 ◽  
Vol 290 (3) ◽  
pp. H1311-H1311 ◽  
Author(s):  
A. Nemes ◽  
Tamás Forster ◽  
Miklós Csanády
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Aortic Stiffness ◽  
Coronary Intervention ◽  
Doppler Velocity ◽  
Coronary Perfusion ◽  
Coronary Flow Velocity Reserve ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve

We examined the hypothesis that a stiff aorta is associated with reduced coronary blood flow (CBF) and CBF response to percutaneous coronary intervention (PCI). Aortic mechanical properties are thought to affect CBF, with increased stiffness associated with decreased coronary perfusion. Animal studies are conflicting, and human evidence is lacking. Even less is known about the effects of aortic stiffness on the CBF response to successful PCI. In 18 subjects undergoing elective PCI, a Doppler velocity guidewire was positioned proximal to a severe coronary stenosis to measure resting and adenosine-induced hyperemic CBF before and after PCI. Stenosis severity was assessed with Doppler velocity and pressure guidewires. Aortic mechanical indexes measured included central pulse-wave velocity (cPWV) and central pulse pressure (cPP). PCI was successful in all subjects (diameter stenosis: 88 ± 9% to 2 ± 7%; coronary flow velocity reserve: 1.8 ± 0.6 to 3.0 ± 0.8; fractional flow reserve: 0.57 ± 0.19 to 0.92 ± 0.06; all P < 0.001). With the adjustment for age and gender, resting and hyperemic CBF were inversely related to cPWV irrespective of the presence of stenosis (resting: before PCI, r2 = 0.452, P < 0.01; after PCI, r2 = 0.261, P = 0.043; hyperemic: before PCI r2 = 0.503, P = 0.005; after PCI r2 = 0.500, P = 0.002), whereas they were related to cPP in absence of stenosis (resting: r2 = 0.368, P = 0.022; hyperemic: r2 = 0.370, P = 0.016). Hyperemic CBF response ( P = 0.005) and hyperemic CBF improvement from PCI ( P = 0.025) were less marked in a stiff aorta than a compliant aorta. A stiff aorta is associated with a reduction in CBF, a lower hyperemic CBF response, and may reduce the improvement in hyperemic CBF after successful PCI.

Aortic stiffness affects the coronary blood flow response to percutaneous coronary intervention

2006 ◽  
Vol 290 (2) ◽  
pp. H624-H630 ◽  
Author(s):  
Michael C. H. Leung ◽  
Ian T. Meredith ◽  
James D. Cameron
Keyword(s):  
Blood Flow ◽  
Percutaneous Coronary Intervention ◽  
Coronary Blood Flow ◽  
Aortic Stiffness ◽  
Coronary Intervention ◽  
Doppler Velocity ◽  
Coronary Perfusion ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Percutaneous Coronary

We examined the hypothesis that a stiff aorta is associated with reduced coronary blood flow (CBF) and CBF response to percutaneous coronary intervention (PCI). Aortic mechanical properties are thought to affect CBF, with increased stiffness associated with decreased coronary perfusion. Animal studies are conflicting, and human evidence is lacking. Even less is known about the effects of aortic stiffness on the CBF response to successful PCI. In 18 subjects undergoing elective PCI, a Doppler velocity guidewire was positioned proximal to a severe coronary stenosis to measure resting and adenosine-induced hyperemic CBF before and after PCI. Stenosis severity was assessed with Doppler velocity and pressure guidewires. Aortic mechanical indexes measured included central pulse-wave velocity (cPWV) and central pulse pressure (cPP). PCI was successful in all subjects (diameter stenosis: 88 ± 9% to 2 ± 7%; coronary flow velocity reserve: 1.8 ± 0.6 to 3.0 ± 0.8; fractional flow reserve: 0.57 ± 0.19 to 0.92 ± 0.06; all P < 0.001). With the adjustment for age and gender, resting and hyperemic CBF were inversely related to cPWV irrespective of the presence of stenosis (resting: before PCI, r2 = 0.452, P < 0.01; after PCI, r2 = 0.261, P = 0.043; hyperemic: before PCI r2 = 0.503, P = 0.005; after PCI r2 = 0.500, P = 0.002), whereas they were related to cPP in absence of stenosis (resting: r2 = 0.368, P = 0.022; hyperemic: r2 = 0.370, P = 0.016). Hyperemic CBF response ( P = 0.005) and hyperemic CBF improvement from PCI ( P = 0.025) were less marked in a stiff aorta than a compliant aorta. A stiff aorta is associated with a reduction in CBF, a lower hyperemic CBF response, and may reduce the improvement in hyperemic CBF after successful PCI.

Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eiji Ichimoto ◽  
Nao Konagai ◽  
Sawako Horie ◽  
Atsushi Hasegawa ◽  
Hirofumi Miyahara ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Flow Ratio ◽  
Operating Characteristics ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Introduction: Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis. Hypothesis: We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis. Methods: A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts. Results: There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80. Conclusions: QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.

Abstract 19177: Loss of Coronary Perfusion Efficiency in Microvascular Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Matthew Lumley ◽  
Matthew Ryan ◽  
Kaleab Asrress ◽  
Rupert Williams ◽  
Satpal Ari ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Microvascular Disease ◽  
Rate Pressure Product ◽  
Coronary Perfusion ◽  
Cardiac Events ◽  
Fractional Flow ◽  
Wave Separation ◽  
Flow Reserve ◽  
Response To Stress

Introduction: Coronary Microvascular Disease (MVD) is associated with an unfavorable prognosis, even in the absence of significant epicardial disease. The pathophysiological basis of increased cardiac events is unclear. The aim of this study was to characterize the forces that govern myocardial perfusion at rest and during stress. Methods: Patients with chest pain syndromes requiring Fractional Flow Reserve (FFR) assessment were screened and those with a FFR>0.80 were included. MVD was defined by coronary flow reserve (CFR) < 2.0. Controls were those with CFR>2.0. Simultaneous intracoronary pressure (P d ) and flow velocity (U) recordings were made at rest and hyperemia. Microvascular Resistance (MR)= P d /U. Wave intensity = dP d /dt x dU/dt and wave separation analysis was used to identify the waves that accelerate and decelerate flow. The proportional contribution of accelerating waves was assessed as an index of coronary perfusion efficiency. Results: 39 consecutive patients were enrolled, 21 had MVD and 18 comprised controls. The groups were matched for atherosclerotic risk factors, rate-pressure-product and P d . Coronary flow velocity in MVD patients was higher at rest (21.5±6.4 vs. 14.1±4.5cms -1 , p < 0.001) but lower during hyperemia (28.3±13.0 vs. 45.1±13.1cms -1 , p < 0.001) compared to controls. While resting MR was lower in MVD (501±162 vs. 755±262 mmHg.cm -1 .s, p = 0.001), hyperemic MR was significantly lower in controls. At rest the magnitude of the accelerating waves was higher in the MVD group than controls. The percentage contribution of accelerating waves increased with hyperemia in controls but decreased in MVD patients (figure). Conclusion: MVD manifests as resting microvascular dilation as well as diminished response to stress. While the normal heart has improved efficiency during hyperemia, in MVD efficiency decreases and as a result, flow augmentation is attenuated. These processes render the myocardium more susceptible to ischemia.

scholarly journals Abnormal Coronary Flow Velocity Reserve After Coronary Intervention Is Associated With Cardiac Marker Elevation

Circulation ◽  
2001 ◽  
Vol 103 (19) ◽  
pp. 2339-2345 ◽  
Author(s):  
Joerg Herrmann ◽  
Michael Haude ◽  
Amir Lerman ◽  
Rainer Schulz ◽  
Lothar Volbracht ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Flow ◽  
Coronary Intervention ◽  
Coronary Flow Velocity Reserve ◽  
Cardiac Marker ◽  
Coronary Flow Velocity
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