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2005, Number 3

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Arch Cardiol Mex 2005; 75 (3)

Coronary physiology and its usefulness for the interventionist cardiologist: Invasive measurement of coronary flow-pressure

Barrera-Ramírez CF, Escaned J

Language: Spanish
References: 87
Page: 335-349
PDF size: 169.16 Kb.


ABSTRACT

One of the most important limitations of coronary angiography is the inability to characterize the physiological significance of an intermediate coronary stenosis. Measuring coronary blood flow and pressure provides unique information that complements anatomic evaluation and facilitates decision-making in the cardiac catheterization unit. This review discusses the fundamental concepts of coronary physiology, methodology, and clinical applications of coronary and flow measurements. (Arch Cardiol Mex 2005; 75: 335-349)


REFERENCES

  1. Martínez-Ríos MA, De los Ríos MF, Cisneros F: Arteriografía coronaria. Arch Inst Cardiol Mex 1970; 40: 68-73.

  2. Topol EJ, Nissen SE: Our preocupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 1995; 92: 2333-42.

  3. Herrman JP, Azar A, Umans VA, Boersma E, von Es GA, Serruys PW: Inter- and intra-observer variability in the qualitative categorization of coronary angiograms. Int J Card Imaging 1996; 12: 21-30.

  4. Leape LL, Park RE, Bashore TM, Harrison JK, Davidson CJ, Brook RH: Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures. Am Heart J 2000; 139: 106-13.

  5. Maurice P, Ourbak P, Rocher R, Sellier P, Guermonprez JL, Fernández F: Angina pectoris con coronariografía normal. Estudio hemodinámico y clínico de 15 casos. Arch Inst Cardiol Mex 1977; 47: 179-88.

  6. Careaga RG, Garduño EJ, Argüero SR: Variabilidad de observador en procedimientos diagnósticos afines a la cirugía cardiotorácica. Gac Med Mex 1994; 130: 476-80.

  7. Rosales GI, Rosales L, Zghaib A: Hallazgos de necropsia en 51 casos de SIDA con daño cardiovascular. Arch Inst Cardiol Mex 1994; 64: 485-90.

  8. Roberts WC, Jones AA: Quantification of coronary arterial narrowing at necropsy in acute transmural myocardial infarction. Analysis and comparison of findings in 27 patients and 22 controls. Circulation 1980; 61: 786-90.

  9. Roberts WC, Jones AA: Quantitation of coronary arterial narrowing at necropsy in sudden coronary death: analysis of 31 patients and comparison with 25 control subjects. Am J Cardiol 1979; 44: 39-45.

  10. Isner JM, Kishel J, Kent KM, Ronan JA Jr, Ross AM, Roberts WC: Accuracy of angiographic determination of left main coronary artery narrowing. Angiographic—histologic correlative analysis in 28 patients. Circulation 1981; 63: 1056-64.

  11. Grondin CM, Dyrda I, Pasternac A, Campeau L, Bourassa MG, Lesperance J: Discrepancies between cineangiographic and post mortem findings in patients with coronary artery disease and recent myocardial revascularization. Circulation 1974; 49: 703-8.

  12. Alfonso F, Goicolea J, Hernández R, Goncalvez M, Segovia J, Bañuelos C, Zarco P, Macaya C: Angioscopic findings during coronary angioplasty of coronary occlusions. J Am Coll Cardiol 1995; 26: 135-41.

  13. Alfonso F, Macaya C, Goicolea J, Iñiguez A, Hernández R, Zamorano J, et al: Intravascular ultrasound imaging of angiographically normal coronary segments in patients with coronary artery disease. Am Heart J 1994; 127: 536-44.

  14. Waller BF: Crackers, breakers, stretchers, drillers, scrapers, shavers, burners, welders and melters: the future treatment of atherosclerotic coronary artery disease? A clinical-morphologic assessment. J Am Coll Cardiol 1989; 13: 969-87.

  15. Naidu RB, Bailey SR: Physiologic assessment of coronary artery stenoses. Curr Probl Cardiol 2001; 26: 423-92.

  16. Seiler C, Meier B: To measure pressure for pleasure-Or is intracoronary pressure gauging pressing? Catheter Cardiovasc Interv 2000; 49: 17-8.

  17. Plotnick GD: Coronary artery bypass surgery to prolong life?: Less anatomy/morephysiology. J Am Coll Cardiol 1986; 8: 749-51.

  18. Barrera-Ramírez CF, Barragán-Campos HM, Sánchez-Guerrero J: Mutaciones del genoma mitocondrial y su expresión clínica en cardiología. Gac Med Méx 2000; 136: 585-94.

  19. Rangel AA: Flujo regional. En: El océano interior. Leyes físicas de la hemodinamia. Rangel AA, Madrid FJ, Marín OMG, Ramón RF. Ed. Fondo de Cultura Económica. México D.F. 2000: 167-96.

  20. Guadalajara BJF, Galván MO, Noguera MJ, Alexanderson RE, Cervantes EJL, Huerta HD: El mecanismo de remodelación en las sobrecargas de volumen del ventrículo izquierdo. Arch Inst Cardiol Mex 1995; 65: 217-28.

  21. Vallejo VE, Guadalajara BJF: Conceptos básicos sobre la genesis y significado de la hipertrofia miocárdica. Arch Inst Cardiol Mex 1996; 66: 360-9.

  22. Salavastru CI, Carmaciu R: The role of the Gregg phenomenon in cardiac performance. Rom J Physiol 1998; 35: 253-7.

  23. Feigl EO: Coronary autoregulation. J Hypertens 1989; 7(Suppl): S55-8.

  24. Guadalajara BJF, Galván MO, Huerta D: Evaluación de la cardiopatía isquémica mediante ecocardiografía dinámica. Arch Inst Cardiol Mex 1997; 67: 231-41.

  25. Kinch JW, Ryan TJ: Right ventricular infarction. N Engl J Med 1994; 330: 1211-7.

  26. Akasaka T, Yoshikawa J, Yoshida K, Hozumi T, Takagi T, Okura H: Comparison of relation of systolic flow of the right coronary artery to pulmonary artery pressure in patients with and without pulmonary hypertension. Am J Cardiol 1996; 76: 240-4.

  27. Escaned J, Cortés J, Goicolea J, Alfonso F, Fernández R, Fernández-Ortiz A, et al: Angiographic and intracoronary physiological assessment of myocardial bridging during dobutamine challenge. Circulation 1999; 100(Suppl. I): 731.

  28. Möhlenkamp S, Hort W, Ge J, Erbel R. Update on myocardial bridging. Circulation 2002; 106: 2616-22.

  29. De Bruyne B, Melin JA, Heyndrickx GR, Wijns W: Autoregulatory plateau in patients with coronary artery disease. Circulation 1990; 94: Pt 2, I-113.

  30. Candell-Riera J, Martín-Comín J, Escaned J, Peteiro J: Physiologic evaluation of coronary circulation. Role of invasive and non invasive techniques. Rev Esp Cardiol 2002; 55: 271-91.

  31. Gould KL: Pressure-flow characteristics of coronary stenoses in unsedated dogs at rest and during coronary vasodilation. Circ Res 1978; 43: 242-3.

  32. Klocke FJ: Measurements of coronary blood flow and degree of stenosis: current clinical implications and continuing uncertainties. J Am Coll Cardiol 1983; 1: 131-41.

  33. Klocke FJ: Measurements of coronary flow reserve: defining pathophysiology versus making decisions about patient care. Circulation 1987; 76: 1183-9.

  34. Hoffman J, Spaan JAE: Pressure-flow relations in coronary circulation. Physiol Rev 1990; 70: 331-90.

  35. Gould KL: Phasic pressure-flow and fluid –dynamic analysis. En: Gould KL. Coronary artery stenosis ans reversing atherosclerosis. 2nd edition. Oxford University Press, Inc. New York. 1999: 55-78.

  36. Escaned J, Baptista J, Di Mario C, Haase J, Ozaki Y, Linker DT, et al: Significance of automated stenosis detection during quantitative angiography. Insights gained from intracoronary ultrasound imaging. Circulation 1996; 94: 966-72.

  37. Foley DP, Escaned J, Strauss BH, di Mario C, Haase J, Keane D, et al: Quantitative coronary angiography (QCA) in interventional cardiology: clinical application of QCA measurements. Prog Cardiovasc Dis 1994; 36: 363-84.

  38. Doucette JW, Corl PD, Payne HM, Flynn AE, Goto M, Nassi M, et al: Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 1992; 85: 1899-1911.

  39. Labovitz AJ, Anthonis DM, Cravens TL, Kern MJ: Validation of volumetric flow measurements by means of a Doppler-tipped coronary angioplasty guide wire. Am Heart J 1998; 126: 1456-61.

  40. Kern MJ: Coronary pressure and flow measurements in the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2001; 54: 378-400.

  41. McGinn AL, White CW, Wilson RF: Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure, and ventricular preload. Circulation 1990; 81: 1319-30.

  42. Wieneke H, Haude M, Ge J, Altmann C, Kaiser S, Baumgart D, et al: Corrected coronary flow velocity reserve: A new concept for assessing coronary perfusion. J Am Coll Cardiol 2000; 35: 1713-20.

  43. Akasaka T, Yoshida K, Hozumi T, Takagi T, Kaji S, Kawamoto T, et al: Retinopathy identifies marked restriction of coronary flow reserve in patients with diabetes mellitus. J Am Coll Cardiol 1997; 30: 935-41.

  44. Kern MJ, Bach RG, Mechem CJ, Caracciolo EA, Aguirre FV, Miller LW, et al: Variations in normal coronary vasodilatory reserve stratified by artery, gender, heart transplantation and coronary artery disease. J Am Coll Cardiol 1996; 28: 1154-60.

  45. Joye JD, Schulman DS, Lasorda D, Farah T, Donohue BC, Reichek N: Intracoronary Doppler guide wire versus stress single-photon emission computed tomographic thallium-201 imaging in assessment of intermediate coronary stenoses. J Am Coll Cardiol 1994; 24: 940-7.

  46. Miller DD, Donohue TJ, Younis LT, Bach RG, Aguirre FV, Wittry MD, et al: Correlation of pharmacological 99mTc-sestamibi myocardial perfusion imaging with poststenotic coronary flow reserve in patients with angiographically intermediate coronary artery stenoses. Circulation 1994; 89: 2150-60.

  47. Baumgart D, Haude M, Goerge G, Ge J, Vetter S, Dagres N, et al: Improved assessment of coronary stenosis severity using the relative flow velocity reserve. Circulation 1998; 98: 40-6.

  48. Kern MJ, Puri S, Bach RG, Donohue TJ, Dupouy P, Caracciolo EA, et al. Abnormal coronary flow velocity reserve after coronary artery stenting in patients: role of relative coronary reserve to assess potential mechanisms. Circulation 1999; 100: 2491-8.

  49. Verberne HJ, Piek JJ, van Liebergen RAM, Koch KT, Schoroeder-Tanka JM, van Royen EA: Functional assessment of coronary artery stenosis by Doppler derived absolute and relative coronary blood flow velocity reserve in comparison with 99mTc MIBI SPECT. Heart 1999; 82: 509-14.

  50. Chamuleau SAJ, Meuwissen M, van Eck-Smit BLF, Koch KT, de Jong A, de Winter RJ, et al: Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestamibi single-photon emission computed tomography in patients with two-vessel coronary artery disease. J Am Coll Cardiol 2001; 37: 1316-22.

  51. De Bruyne B, Bartunek J, Sys SU, Pijls NHJ, Heyndrickx GR, Wijns W: Simultaneous coronary pressure and flow velocity measurements in humans. Feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. Circulation 1996; 94: 1842-9.

  52. Pijls NHJ, Kern MJ, Yock PG, De Bruyne B: Practice and potential pitfalls of coronary pressure measurement. Catheter Cardiovasc Interv 2000; 49: 1-16.

  53. Pijls NHJ, Van Gelder B, Van der Voort P, Peels K, Bracke FA, Bonnier HJ, el Gamal MI: Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 1995; 92: 3183-93.

  54. De Bruyne B, Paulus WJ, Pijls NHJ: Rationale and application of coronary transstenotic pressure gradient measurements. Cathet Cardiovasc Diagn 1994; 33: 250-61.

  55. Pijls NHJ, De Bruyne B: Coronary pressure. Eds. Kuwler Academic Publishers. Dordrecht 1997: 60-8.

  56. Pijls NHJ, De Bruyne B, Peels K, Van Der Voort PH, Bonnier HJ, Bartunek J, et al: Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 1996; 334: 1703-8.

  57. De Bruyne B, Bartunek J, Sys SU, Heyndrickx GR: Relation between myocardial fractional flow reserve calculated from coronary pressure measurements and exercise-induced myocardial ischemia. Circulation 1995; 92: 39-46.

  58. Bartunek J, Van Schuerbeeck E, de Bruyne B: Comparison of exercise electrocardiography and dobutamine echocardiography with invasively assessed myocardial fractional flow reserve in evaluation of severity of coronary arterial narrowing. Am J Cardiol 1997; 79: 478-81.

  59. Kern MJ: Coronary physiology revisited. Practical insights from the cardiac catheterization laboratory. Circulation 2000; 101: 1344-51.

  60. Abe M, Tomiyama H, Yoshida H, Doba N: Diastolic fractional flow reserve to assess the functional severity of moderate coronary artery stenoses: comparison with fractional flow reserve and coronary flow velocity reserve. Circulation 2000; 102: 2365-70.

  61. Escaned J, Flores A, Cortés J, Alfonso F, Hernández R, Fernández-Ortiz A, et al: Influence of flow characteristics of the right and left coronary arteries on fractional flow reserve measurements. Circulation 2000; 102(Suppl II): 639.

  62. Wilson RF, White CW: Intracoronary papaverine: an ideal coronary vasodilator for studies of the coronary circulation in conscious humans. Circulation 1986; 73: 444-51.

  63. Kern MJ, Deligonul U, Tatineni S, Serota H, Aguirre F, Hilton TC: Intravenous adenosine: continuous infusion and low dose bolus administration for determination of coronary vasodilator reserve in patients with and without coronary artery disease. J Am Coll Cardiol 1991; 18: 718-29.

  64. Freilich A, Tepper D: Adenosine and its cardiovascular effects. Am Heart J 1992; 123: 1324-8.

  65. López-Palop R, Pinar E, Lozano I, Carrillo P, Cortés R, Pico F, et al: Clinical utilization of the coronary pressure wire. Rev Esp Cardiol 2002; 55: 251-7.

  66. Qian J, Ge J, Baumgart D, Oldenburg O, Haude M, Sack S, et al: Safety of intracoronary Doppler flow measurement. Am Heart J 2000; 140: 502-10.

  67. Kern MJ, Donohue TJ, Aguirre FV, Bach RG, Caracciolo EA, Wolford T, et al: Clinical outcome of deferring angioplasty in patients with normal translesional pressure-flow velocity measurements. J Am Coll Cardiol 1995; 25: 178-87.

  68. Ferrari M, Schnell B, Werner GS, Figulla HR: Safety of deferring angioplasty in patients with normal coronary flow velocity reserve. J Am Coll Cardiol 1999; 33: 82-7.

  69. Bech GJ, De Bruyne B, Bonnier HJ, Bartunek J, Wijns W, Peels K, et al. Long-term follow-up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measurement. J Am Coll Cardiol 1998; 31: 841-7.

  70. Rieber J, Schiele TM, Koenig A, Erhard I, Segmiller T, Stempfle HU, et al: Long-term safety of therapy stratification in patients with intermediate coronary lesions based on intracoronary pressure measurements. Am J Cardiol 2002; 90: 1160-4.

  71. Bech GJ, De Bruyne B, Pijls NH, de Muinck ED, Hoorntje JC, Escaned J, et al: Fractional flow reserve to determine the appropriateness of angioplasty in moderate coronary stenosis: a randomized trial. Circulation 2001; 103: 2928-34.

  72. Chamuleau SA, Tio RA, de Cock CC, de Muinck ED, Pijls NH, van Eck-Smit BL, et al. Prognostic value of coronary blood flow velocity and myocardial perfusion in intermediate coronary narrowings and multivessel disease. J Am Coll Cardiol 2002; 39: 852-8.

  73. Bech GJ, Droste H, Pijls NH, De Bruyne B, Bonnier JJ, Michels HR, et-al: Value of fractional flow reserve in making decisions about bypass surgery for equivocal left main coronary artery disease. Heart 2001; 86: 547-52.

  74. Serruys PW, di Mario C, Piek J, Schroeder E, Vrints C, Probst P, et al: Prognostic value of intracoronary flow velocity and diameter stenosis in assessing the short- and long-term outcomes of coronary balloon angioplasty: the DEBATE Study (Doppler Endpoints Balloon Angioplasty Trial Europe). Circulation 1997; 96: 3369-77.

  75. Lafont A, Dubois-Rande JL, Steg PG, Dupouy P, Carrie D, Coste P, et al: The French Randomized Optimal Stenting Trial: a prospective evaluation of provisional stenting guided by coronary velocity reserve and quantitative coronary angiography. F.R.O.S.T. Study Group. J Am Coll Cardiol 2000; 36: 404-9.

  76. Serruys PW, de Bruyne B, Carlier S, Sousa JE, Piek J, Muramatsu, et al: Randomized comparison of primary stenting and provisional balloon angioplasty guided by flow velocity measurement. Doppler Endpoints Balloon Angioplasty Trial Europe (DEBATE) II Study Group. Circulation 2000; 102: 2930-7.

  77. Di Mario C, Moses JW, Anderson TJ, Bonan R, Muramatsu T, Jain AC, et al: Randomized comparison of elective stent implantation and coronary balloon angioplasty guided by online quantitative angiography and intracoronary Doppler. DESTINI Study Group (Doppler Endpoint STenting INternational Investigation). Circulation 2000; 102: 2938-44.

  78. Bech GJ, Pijls NHJ, De Bruyne B, Peels KH, Michels HR, Bonnier HJ, et al: Usefulness of fractional flow reserve to predict clinical outcome after balloon angioplasty. Circulation 1999; 99: 883-8.

  79. Hanekamp CE, Koolen JJ, Pijls NH, Michels HR, Bonnier HJ: Comparison of quantitative coronary angiography, intravascular ultrasound, and coronary pressure measurement to assess optimum stent deployment. Circulation 1999; 99: 1015-21.

  80. Fearon WF, Luna J, Samady H, Powers ER, Feldman T, Dib N, et al: Fractional flow reserve compared with intravascular ultrasound guidance for optimizing stent deployment. Circulation 2001; 104: 1917-22.

  81. Pijls NHJ, Klauss V, Siebert U, Powers E, Takazawa K, Fearon WF, Escaned J, et al: Coronary pressure measurement after stenting predicts adverse events at follow-up. A multicenter registry. Circulation 2002; 105: 2950-54.

  82. Haude M, Baumgart D, Verna E, Piek JJ, Vrints C, Probst P, Erbel R: Intracoronary Doppler- and quantitative coronary angiography-derived predictors of major adverse cardiac events after stent implantation. Circulation 2001; 103: 1212-7.

  83. Emanuelsson H, Dohnal M, Lamm C, Tenerz L: Initial experiences with a miniaturized pressure transducer during coronary angioplasty. Cathet Cardiovasc Diagn 1991; 24: 137-43.

  84. De Bruyne B, Pijls NH, Paulus WJ, Vantrimpont PJ, Sys SU, Heyndrickx GR: Trans-stenotic coronary pressure gradient measurement in humans: in vitro and in vivo evaluation of a new pressure monitoring angioplasty guide wire. J Am Coll Cardiol 1993; 22: 119-26.

  85. Leiboff R, Bren G, Katz R, Korkegi R, Ross A: Determinants of trans-stenotic gradients observed during angioplasty: an experimental model. Am J Cardiol 1983; 52(10): 1311-7.

  86. Escudero EM, Ronderos R, Corneli D: Microcirculación coronaria: anatomía, fisiología y fisiopatología. Su implicancia en el estudio de la perfusión miocárdica con eco-contraste. Rev Fed Arg Cardiol 2001; 30: 53-61.

  87. Kern MJ, De Bruyne B, Pijls NHJ: From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac catheterization laboratory. J Am Coll Cardiol 1997; 30: 613-20.




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