TY - JOUR
T1 - Phasic flow patterns of right versus left coronary arteries in patients undergoing clinical physiological assessment
AU - Seligman, Henry
AU - Nijjer, Sukhjinder S.
AU - van de Hoef, Tim P.
AU - de Waard, Guus A.
AU - Mejía-Rentería, Hernán
AU - Echavarria-Pinto, Mauro
AU - Shun-Shin, Matthew J.
AU - Howard, James P.
AU - Cook, Christopher M.
AU - Warisawa, Takayuki
AU - Ahmad, Yousif
AU - Androshchuk, Vitaliy
AU - Rajkumar, Christopher
AU - Nowbar, Alexandra
AU - Kelshiker, Mihir A.
AU - van Lavieren, Martijn A.
AU - Meuwissen, Martijn
AU - Danad, Ibrahim
AU - Knaapen, Paul
AU - Sen, Sayan
AU - Al-Lamee, Rasha
AU - Mayet, Jamil
AU - Escaned, Javier
AU - Piek, Jan J.
AU - van Royen, Niels
AU - Davies, Justin E.
AU - Francis, Darrel P.
AU - Petraco, Ricardo
N1 - Funding Information: Outside of the submitted work J. Mayet has a patent for iFR technology for assessment of coronary stenoses with royalties paid to Imperial Innovations, C.M. Cook has received personal fees from Philips, and S.S. Nijjer reports that he has received honoraria for speaking on Coronary Physiology from Philips. H. Seligman has received educational funding from Amgen. J.E. Davies reports grants and personal fees from Philips Volcano and has a patent IP pertaining to iFR technology with royalties paid to Philips Funding Information: The authors are grateful for the infrastructural support from the National Institute of Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. C. Rajkumar is a PhD Training Fellow at the Medical Research Council (Grant Number MR/ S021108/1). J.P Howard is a PhD Training Fellow at the Wellcome Trust (Grant number 212183/Z/18/Z). A. Nowbar is supported by the NIHR Imperial Biomedical Research Centre (BRC). Funding Information: Volcano. R. Al-Lamee has received speaking fees from Philips Volcano. R. Petraco has acted as consultant to Philips. T.P. van de Hoef has served as a speaker at educational events organised by Philips Volcano, St. Jude Medical (now Abbott), and Boston Scientific. J.J. Piek reports personal fees and non-financial support from Philips Volcano. S. Sen reports speaking fees from Philips, Pfizer and AstraZeneca and an educational grant from Medtronic. N. van Royen reports grants from Philips, Abbott, and Biotronik and personal fees from Medtronic. The other authors have no conflicts of interest to declare. Publisher Copyright: © Europa Digital & Publishing 2022.
PY - 2022/2/18
Y1 - 2022/2/18
N2 - BACKGROUND: Coronary blood flow in humans is known to be predominantly diastolic. Small studies in animals and humans suggest that this is less pronounced or even reversed in the right coronary artery (RCA). AIMS: This study aimed to characterise the phasic patterns of coronary flow in the left versus right coronary arteries of patients undergoing invasive physiological assessment. METHODS: We analysed data from the Iberian-Dutch-English Collaborators (IDEAL) study. A total of 482 simultaneous pressure and flow measurements from 301 patients were included in our analysis. RESULTS: On average, coronary flow was higher in diastole both at rest and during hyperaemia in both the RCA and LCA (mean diastolic-to-systolic velocity ratio [DSVR] was, respectively, 1.85±0.70, 1.76±0.58, 1.53±0.34 and 1.58±0.43 for LCArest, LCAhyp, RCArest and RCAhyp, p<0.001 for between-vessel comparisons). Although the type of RCA dominance affected the DSVR magnitude (RCAdom=1.55±0.35, RCAco-dom=1.40±0.27, RCAnon-dom=1.35; standard deviation not reported as n=3), systolic flow was very rarely predominant (DSVR was greater than or equal to 1.00 in 472/482 cases [97.9%] overall), with equal prevalence in the LCA. Stenosis severity or microvascular dysfunction had a negligible impact on DSVR in both the RCA and LCA (DSVR x hyperaemic stenosis resistance R2 =0.018, p=0.03 and DSVR x coronary flow reserve R2 <0.001, p=0.98). CONCLUSIONS: In patients with coronary artery disease undergoing physiological assessment, diastolic flow predominance is seen in both left and right coronary arteries. Clinical interpretation of coronary physiological data should therefore not differ between the left and the right coronary systems.
AB - BACKGROUND: Coronary blood flow in humans is known to be predominantly diastolic. Small studies in animals and humans suggest that this is less pronounced or even reversed in the right coronary artery (RCA). AIMS: This study aimed to characterise the phasic patterns of coronary flow in the left versus right coronary arteries of patients undergoing invasive physiological assessment. METHODS: We analysed data from the Iberian-Dutch-English Collaborators (IDEAL) study. A total of 482 simultaneous pressure and flow measurements from 301 patients were included in our analysis. RESULTS: On average, coronary flow was higher in diastole both at rest and during hyperaemia in both the RCA and LCA (mean diastolic-to-systolic velocity ratio [DSVR] was, respectively, 1.85±0.70, 1.76±0.58, 1.53±0.34 and 1.58±0.43 for LCArest, LCAhyp, RCArest and RCAhyp, p<0.001 for between-vessel comparisons). Although the type of RCA dominance affected the DSVR magnitude (RCAdom=1.55±0.35, RCAco-dom=1.40±0.27, RCAnon-dom=1.35; standard deviation not reported as n=3), systolic flow was very rarely predominant (DSVR was greater than or equal to 1.00 in 472/482 cases [97.9%] overall), with equal prevalence in the LCA. Stenosis severity or microvascular dysfunction had a negligible impact on DSVR in both the RCA and LCA (DSVR x hyperaemic stenosis resistance R2 =0.018, p=0.03 and DSVR x coronary flow reserve R2 <0.001, p=0.98). CONCLUSIONS: In patients with coronary artery disease undergoing physiological assessment, diastolic flow predominance is seen in both left and right coronary arteries. Clinical interpretation of coronary physiological data should therefore not differ between the left and the right coronary systems.
KW - Blood Flow Velocity/physiology
KW - Constriction, Pathologic
KW - Coronary Circulation/physiology
KW - Coronary Vessels/diagnostic imaging
KW - Diastole
KW - Humans
KW - Hyperemia
KW - fractional flow reserve
KW - other technique
KW - stable angina
UR - http://www.scopus.com/inward/record.url?scp=85124850822&partnerID=8YFLogxK
U2 - https://doi.org/10.4244/EIJ-D-21-00189
DO - https://doi.org/10.4244/EIJ-D-21-00189
M3 - Article
C2 - 34338643
SN - 1774-024X
VL - 17
SP - 1260
EP - 1270
JO - EuroIntervention
JF - EuroIntervention
IS - 15
ER -