Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability

Matthew Ryan; Kalpa De Silva; Holly Morgan; Kevin O'Gallagher; Ozan M. Demir; Haseeb Rahman; Howard Ellis; Luke Dancy; Daniel Sado; Julian Strange; Narbeh Melikian; Michael Marber; Ajay M. Shah; Amedeo Chiribiri; Divaka Perera

doi:10.1161/CIRCINTERVENTIONS.122.012394

Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability

Matthew Ryan, Kalpa De Silva, Holly Morgan, Kevin O'Gallagher, Ozan M. Demir, Haseeb Rahman, Howard Ellis, Luke Dancy, Daniel Sado, Julian Strange, Narbeh Melikian, Michael Marber, Ajay M. Shah, Amedeo Chiribiri, Divaka Perera^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

1 Citation (Scopus)

Abstract

Background: Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. Methods: Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. Results: Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m^-2s^-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m^-2s^-1had 86% sensitivity and 76% specificity. Conclusions: Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.

Original language	English
Article number	E012394
Journal	Circulation: Cardiovascular Interventions
Volume	15
Issue number	12
Early online date	20 Dec 2022
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.122.012394
Publication status	Published - Dec 2022

Keywords

coronary artery disease
coronary physiology
heart failure
myocardial hibernation
reduced ejection fraction

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This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1161/CIRCINTERVENTIONS.122.012394

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Ryan, M., De Silva, K., Morgan, H., O'Gallagher, K., Demir, O. M., Rahman, H., Ellis, H., Dancy, L., Sado, D., Strange, J., Melikian, N., Marber, M., Shah, A. M., Chiribiri, A., & Perera, D. (2022). Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability. Circulation: Cardiovascular Interventions, 15(12), Article E012394. https://doi.org/10.1161/CIRCINTERVENTIONS.122.012394

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title = "Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability",

abstract = "Background: Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. Methods: Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. Results: Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2s-1had 86% sensitivity and 76% specificity. Conclusions: Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.",

keywords = "coronary artery disease, coronary physiology, heart failure, myocardial hibernation, reduced ejection fraction",

author = "Matthew Ryan and {De Silva}, Kalpa and Holly Morgan and Kevin O'Gallagher and Demir, {Ozan M.} and Haseeb Rahman and Howard Ellis and Luke Dancy and Daniel Sado and Julian Strange and Narbeh Melikian and Michael Marber and Shah, {Ajay M.} and Amedeo Chiribiri and Divaka Perera",

note = "Funding Information: This work was supported by the British Heart Foundation through a clinical research training fellowship award (FS/18/16/33396). The authors are further supported through grants from the British Heart Foundation (FS/16/49/32320, FS/CRTF/21/24190, PG/19/9/34228, CH/1999001/11735, RE/18/2/34213, RM/17/3/33381) and from the National Institute for Health Research (NIHR130593 and 10/57/67). From the British Heart Foundation Centre of Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King{\textquoteright}s College London, London, United Kingdom and the School of Biomedical Engineering and Imaging Sciences, King{\textquoteright}s College London, London, United Kingdom, and the National Institute for Health Research via the Biomedical Research Centre award to Guy{\textquoteright}s and St. Thomas{\textquoteright} Hospital and King{\textquoteright}s College London. Publisher Copyright: {\textcopyright} 2022 Lippincott Williams and Wilkins. All rights reserved.",

year = "2022",

month = dec,

doi = "10.1161/CIRCINTERVENTIONS.122.012394",

language = "English",

volume = "15",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

number = "12",

}

Ryan, M , De Silva, K , Morgan, H , O'Gallagher, K , Demir, OM , Rahman, H , Ellis, H, Dancy, L, Sado, D, Strange, J, Melikian, N , Marber, M , Shah, AM , Chiribiri, A & Perera, D 2022, 'Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability', Circulation: Cardiovascular Interventions, vol. 15, no. 12, E012394. https://doi.org/10.1161/CIRCINTERVENTIONS.122.012394

TY - JOUR

T1 - Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability

AU - Ryan, Matthew

AU - De Silva, Kalpa

AU - Morgan, Holly

AU - O'Gallagher, Kevin

AU - Demir, Ozan M.

AU - Rahman, Haseeb

AU - Ellis, Howard

AU - Dancy, Luke

AU - Sado, Daniel

AU - Strange, Julian

AU - Melikian, Narbeh

AU - Marber, Michael

AU - Shah, Ajay M.

AU - Chiribiri, Amedeo

AU - Perera, Divaka

N1 - Funding Information: This work was supported by the British Heart Foundation through a clinical research training fellowship award (FS/18/16/33396). The authors are further supported through grants from the British Heart Foundation (FS/16/49/32320, FS/CRTF/21/24190, PG/19/9/34228, CH/1999001/11735, RE/18/2/34213, RM/17/3/33381) and from the National Institute for Health Research (NIHR130593 and 10/57/67). From the British Heart Foundation Centre of Excellence at the School of Cardiovascular and Metabolic Medicine and Sciences, King’s College London, London, United Kingdom and the School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom, and the National Institute for Health Research via the Biomedical Research Centre award to Guy’s and St. Thomas’ Hospital and King’s College London. Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved.

PY - 2022/12

Y1 - 2022/12

N2 - Background: Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. Methods: Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. Results: Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2s-1had 86% sensitivity and 76% specificity. Conclusions: Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.

AB - Background: Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. Methods: Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. Results: Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2s-1had 86% sensitivity and 76% specificity. Conclusions: Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.

KW - coronary artery disease

KW - coronary physiology

KW - heart failure

KW - myocardial hibernation

KW - reduced ejection fraction

UR - http://www.scopus.com/inward/record.url?scp=85144126550&partnerID=8YFLogxK

U2 - 10.1161/CIRCINTERVENTIONS.122.012394

DO - 10.1161/CIRCINTERVENTIONS.122.012394

M3 - Article

C2 - 36538582

AN - SCOPUS:85144126550

SN - 1941-7640

VL - 15

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 12

M1 - E012394

ER -

Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability

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