TY - JOUR
T1 - Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian-Dutch-English (IDEAL) collaborators
AU - Nijjer, Sukhjinder S.
AU - de Waard, Guus A.
AU - Sen, Sayan
AU - van de Hoef, Tim P.
AU - Petraco, Ricardo
AU - Echavarría-Pinto, Mauro
AU - van Lavieren, Martijn A.
AU - Meuwissen, Martijn
AU - Danad, Ibrahim
AU - Knaapen, Paul
AU - Escaned, Javier
AU - Piek, Jan J.
AU - Davies, Justin E.
AU - van Royen, Niels
PY - 2016/7/7
Y1 - 2016/7/7
N2 - Background Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. Methods Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients and results were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR <= 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, P-trend <0.001 in a curvilinear pattern. Resting flow was unaffected by stenosis severity and was consistent across all strata of stenosis (P-trend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures (P-trend <0.001 for both). Microvascular resistance declines with stenosis severity under resting conditions <0.001), but was unchanged at hyperaemia (2.3 +/- 1.1 mmHg/cm/s; P-trend = 0.19). Conclusions With progressive stenosis severity, TG rises. However, white hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses
AB - Background Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. Methods Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients and results were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR <= 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, P-trend <0.001 in a curvilinear pattern. Resting flow was unaffected by stenosis severity and was consistent across all strata of stenosis (P-trend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures (P-trend <0.001 for both). Microvascular resistance declines with stenosis severity under resting conditions <0.001), but was unchanged at hyperaemia (2.3 +/- 1.1 mmHg/cm/s; P-trend = 0.19). Conclusions With progressive stenosis severity, TG rises. However, white hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses
KW - Autoregulation
KW - Microvascular resistance
KW - Physiological Lesion assessment
KW - Stenosis
U2 - https://doi.org/10.1093/eurheartj/ehv626
DO - https://doi.org/10.1093/eurheartj/ehv626
M3 - Article
C2 - 26612582
SN - 0195-668X
VL - 37
SP - 2069
EP - 2080
JO - European Heart Journal
JF - European Heart Journal
IS - 26
ER -