Resting coronary flow varies with normal cardiac catheter laboratory stimuli

Bhavik N. Modi; Haseeb Rahman; Satpal Arri; Howard Ellis; Mark T. Mills; Rupert Williams; Kaleab Asrress; Brian Clapp; Simon Redwood; Divaka Perera

doi:10.1016/j.carrev.2018.10.010

Resting coronary flow varies with normal cardiac catheter laboratory stimuli

Bhavik N. Modi, Haseeb Rahman, Satpal Arri, Howard Ellis, Mark T. Mills, Rupert Williams, Kaleab Asrress, Brian Clapp, Simon Redwood, Divaka Perera

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

2 Citations (Scopus)

229 Downloads (Pure)

Abstract

Background Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio (iFR) and the ratio of distal coronary to aortic pressure at rest (resting Pd/Pa). Their reliability may, theoretically, be more susceptible to changes in microvascular tone and coronary flow. This study aimed to assess variability of resting coronary flow with normal catheter laboratory stimuli. Methods Simultaneous intracoronary pressure (Pd) and Doppler Average Peak Flow Velocity (APV) recordings were made at rest and following the verbal warning preceding an intravenous adenosine infusion. Results: 72 patients undergoing elective angiography were recruited (mean age 62 years, 52.7% male) with a wide range of coronary artery disease severity (FFR 0.86 ± 0.09). Average peak flow velocity varied significantly between measurements at rest and just prior to commencement of adenosine, with a mean variation of 10.2% (17.82 ± 9.41 cm/s vs. 19.63 ± 10.44 cm/s, p 

Original language	English
Journal	Cardiovascular Revascularization Medicine
Early online date	15 Oct 2018
DOIs	https://doi.org/10.1016/j.carrev.2018.10.010
Publication status	E-pub ahead of print - 15 Oct 2018

Keywords

Coronary artery disease
Fractional flow reserve
Instantaneous wave-free ratio

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10.1016/j.carrev.2018.10.010

Resting coronary flow varies_MODI_Firstonline15October2018_GREEN AAM (CC BY-NC-ND)Accepted author manuscript, 2.67 MBLicence: CC BY-NC-ND

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title = "Resting coronary flow varies with normal cardiac catheter laboratory stimuli",

abstract = "Background Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio (iFR) and the ratio of distal coronary to aortic pressure at rest (resting Pd/Pa). Their reliability may, theoretically, be more susceptible to changes in microvascular tone and coronary flow. This study aimed to assess variability of resting coronary flow with normal catheter laboratory stimuli. Methods Simultaneous intracoronary pressure (Pd) and Doppler Average Peak Flow Velocity (APV) recordings were made at rest and following the verbal warning preceding an intravenous adenosine infusion. Results: 72 patients undergoing elective angiography were recruited (mean age 62 years, 52.7% male) with a wide range of coronary artery disease severity (FFR 0.86 ± 0.09). Average peak flow velocity varied significantly between measurements at rest and just prior to commencement of adenosine, with a mean variation of 10.2% (17.82 ± 9.41 cm/s vs. 19.63 ± 10.44 cm/s, p ",

keywords = "Coronary artery disease, Fractional flow reserve, Instantaneous wave-free ratio",

author = "Modi, {Bhavik N.} and Haseeb Rahman and Satpal Arri and Howard Ellis and Mills, {Mark T.} and Rupert Williams and Kaleab Asrress and Brian Clapp and Simon Redwood and Divaka Perera",

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doi = "10.1016/j.carrev.2018.10.010",

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T1 - Resting coronary flow varies with normal cardiac catheter laboratory stimuli

AU - Modi, Bhavik N.

AU - Rahman, Haseeb

AU - Arri, Satpal

AU - Ellis, Howard

AU - Mills, Mark T.

AU - Williams, Rupert

AU - Asrress, Kaleab

AU - Clapp, Brian

AU - Redwood, Simon

AU - Perera, Divaka

PY - 2018/10/15

Y1 - 2018/10/15

N2 - Background Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio (iFR) and the ratio of distal coronary to aortic pressure at rest (resting Pd/Pa). Their reliability may, theoretically, be more susceptible to changes in microvascular tone and coronary flow. This study aimed to assess variability of resting coronary flow with normal catheter laboratory stimuli. Methods Simultaneous intracoronary pressure (Pd) and Doppler Average Peak Flow Velocity (APV) recordings were made at rest and following the verbal warning preceding an intravenous adenosine infusion. Results: 72 patients undergoing elective angiography were recruited (mean age 62 years, 52.7% male) with a wide range of coronary artery disease severity (FFR 0.86 ± 0.09). Average peak flow velocity varied significantly between measurements at rest and just prior to commencement of adenosine, with a mean variation of 10.2% (17.82 ± 9.41 cm/s vs. 19.63 ± 10.44 cm/s, p 

AB - Background Growing evidence supports physiology-guided revascularization, with Fractional Flow Reserve (FFR) the most commonly used invasive measure of coronary blood flow impairment at the time of diagnostic angiography. Recently, there has been growing interest in stenosis severity indices measured at rest, such as Instantaneous Wave Free Ratio (iFR) and the ratio of distal coronary to aortic pressure at rest (resting Pd/Pa). Their reliability may, theoretically, be more susceptible to changes in microvascular tone and coronary flow. This study aimed to assess variability of resting coronary flow with normal catheter laboratory stimuli. Methods Simultaneous intracoronary pressure (Pd) and Doppler Average Peak Flow Velocity (APV) recordings were made at rest and following the verbal warning preceding an intravenous adenosine infusion. Results: 72 patients undergoing elective angiography were recruited (mean age 62 years, 52.7% male) with a wide range of coronary artery disease severity (FFR 0.86 ± 0.09). Average peak flow velocity varied significantly between measurements at rest and just prior to commencement of adenosine, with a mean variation of 10.2% (17.82 ± 9.41 cm/s vs. 19.63 ± 10.44 cm/s, p 

KW - Coronary artery disease

KW - Fractional flow reserve

KW - Instantaneous wave-free ratio

U2 - 10.1016/j.carrev.2018.10.010

DO - 10.1016/j.carrev.2018.10.010

M3 - Article

SN - 1553-8389

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

ER -

Resting coronary flow varies with normal cardiac catheter laboratory stimuli

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Keywords

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