Dataset Information

Noninvasive transthoracic doppler flow velocity and invasive thermodilution to assess coronary flow reserve.

ABSTRACT:

Background

Coronary flow reserve (CFR) provides prognostication and coronary physiological information, including epicardial coronary stenosis and microvascular function. The relationship between stress transthoracic Doppler echocardiography (TDE)-derived coronary flow velocity reserve (CFR_S-TDE) and thermodilution-derived coronary flow reserve (CFR_thermo) before and after elective percutaneous coronary intervention (PCI) remains unclear.

Methods

This single-center prospective registry study evaluated patients who underwent fractional flow reserve (FFR)-guided elective PCI for left anterior descending artery (LAD) lesions with wire-based invasive physiological measurements and pre- and post-PCI stress TDE examinations.

Results

A total of 174 LAD lesions from 174 patients were included in the final analysis. A modest correlation was detected between the pre-PCI CFR_S-TDE and the pre-PCI CFR_thermo (r=0.383, P<0.001). The frequently used CFR_S-TDE threshold of 2.0 corresponded to a pre-PCI CFR_thermo of 2.18. Pre-PCI CFR_S-TDE underestimated pre-PCI CFR_thermo [1.89 (1.44-2.31) vs. 2.05 (1.38-2.93), P<0.001]. Both CFR_S-TDE and CFR_thermo increased significantly post-PCI [pre-PCI CFR_S-TDE 1.89 vs. post-PCI CFR_S-TDE 2.33, P<0.001; pre-PCI CFR_thermo 2.05 (1.38-2.93) vs. post-PCI CFR_thermo 2.59 (1.63-3.55), P<0.001]. In contrast, there was no significant relationship between changes in CFR_S-TDE and changes in CFR_thermo after PCI (r=0.008, P=0.915) or between post-PCI CFR_S-TDE and post-PCI CFR_thermo (r=0.054, P=0.482).

Conclusions

Pre-PCI CFR_S-TDE and CFR_thermo are modestly correlated, but post-PCI CFR_S-TDE and CFR_thermo have no correlation. CFR_S-TDE and CFR_thermo are not interchangeable, particularly post-PCI, suggesting that the two metrics represent different coronary physiologies after PCI.

SUBMITTER: Matsuda K

PROVIDER: S-EPMC10784095 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Publications

Noninvasive transthoracic doppler flow velocity and invasive thermodilution to assess coronary flow reserve.

Matsuda Kazuki K Hoshino Masahiro M Usui Eisuke E Hanyu Yoshihiro Y Sugiyama Tomoyo T Kanaji Yoshihisa Y Hada Masahiro M Nagamine Tatsuhiro T Nogami Kai K Ueno Hiroki H Sayama Kodai K Sakamoto Tatsuya T Yonetsu Taishi T Sasano Tetsuo T Kakuta Tsunekazu T

Quantitative imaging in medicine and surgery 20230904 1

<h4>Background</h4>Coronary flow reserve (CFR) provides prognostication and coronary physiological information, including epicardial coronary stenosis and microvascular function. The relationship between stress transthoracic Doppler echocardiography (TDE)-derived coronary flow velocity reserve (CFR<sub>S-TDE</sub>) and thermodilution-derived coronary flow reserve (CFR<sub>thermo</sub>) before and after elective percutaneous coronary intervention (PCI) remains unclear.<h4>Methods</h4>This single- ...[more]

PMID: 38223097

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Project description:ObjectivesThe aim of this study was to compare Doppler flow velocity and thermodilution-derived indexes and to determine the optimal thermodilution-based diagnostic thresholds for coronary flow reserve (CFR).BackgroundThe majority of clinical data and diagnostic thresholds for flow-based indexes are derived from Doppler measurements, and correspondence with thermodilution-derived indices remain unclear.MethodsAn international multicenter registry was conducted among patients who had coronary flow measurements using both Doppler and thermodilution techniques in the same vessel and during the same procedure.ResultsPhysiological data from 250 vessels (in 149 patients) were included in the study. A modest correlation was found between thermodilution-derived CFR (CFRthermo) and Doppler-derived CFR (CFRDoppler) (r2 = 0.36; P < 0.0001). CFRthermo overestimated CFRDoppler (mean 2.59 ± 1.46 vs 2.05 ± 0.89; P < 0.0001; mean bias 0.59 ± 1.24 by Bland-Altman analysis), the relationship being described by the equation CFRthermo = 1.04 × CFRDoppler + 0.50. The commonly used dichotomous CFRthermo threshold of 2.0 had poor sensitivity at predicting a CFRDoppler value <2.5. The optimal CFRthermo threshold was 2.5 (sensitivity 75.54%, specificity 81.25%). There was only a weak correlation between hyperemic microvascular resistance and index of microvascular resistance (r2 = 0.19; P < 0.0001), due largely to variation in the measurement of flow by each modality. Forty-four percent of patients were discordantly classified as having abnormal microvascular resistance by hyperemic microvascular resistance (≥2.5 mm Hg · cm-1 · s) and index of microvascular resistance (≥25).ConclusionsCFR calculated by thermodilution overestimates Doppler-derived CFR, while both parameters show modest correlation. The commonly used CFRthermo threshold of 2.0 has poor sensitivity for identifying vessels with diminished CFR, but using the same binary diagnostic threshold as for Doppler (<2.5) yields reasonable diagnostic accuracy. There was only a weak correlation between microvascular resistance indexes assessed by the 2 modalities.

Project description:IntroductionCoronary flow velocity reserve (CFVR) is an important prognostic marker in patients with stable coronary artery disease (CAD). Beta-blockers and ivabradine have been shown to improve CFVR in patients with stable CAD, but their effects were never compared. The aim of the current study was to compare the effects of bisoprolol and ivabradine on CFVR in patients with stable CAD.MethodsPatients in sinus rhythm with stable CAD were enrolled in this prospective, randomized, double-blind trial. Patients had to be in a stable condition for at least 15 days before enrollment, on their usual therapy. Patients who were receiving beta-blockers or ivabradine entered a 2-week washout period from these drugs before randomization. Transthoracic Doppler-derived CFVR was assessed in left anterior descending coronary artery, and was calculated as the ratio of hyperemic to baseline diastolic coronary flow velocity (CFV). Hyperemic CFV was obtained using dipyridamole administration using standard protocols. After CFVR assessment, patients were randomized to ivabradine or bisoprolol and entered an up-titration phase, and CFVR was assessed again 1 month after the end of the up-titration phase.ResultsFifty-nine patients (38 male, 21 female; mean age 69 ± 9 years) were enrolled. Transthoracic Doppler-derived assessment of CFV and CFVR was successfully performed in all patients. Baseline characteristics were similar between the bisoprolol and ivabradine groups. No patient dropped out during the study. At baseline, rest and hyperemic peak CFV as well as CFVR was not significantly different in the ivabradine and bisoprolol groups. After the therapy, resting peak CFV significantly decreased in both the ivabradine and bisoprolol groups, but there was no significant difference between the groups (ivabradine group 20.7 ± 4.6 vs. 22.8 ± 5.2, P < 0.001; bisoprolol group 20.1 ± 4.1 vs. 22.1 ± 4.3, P < 0.001). However, hyperemic peak CFV significantly increased in both groups, but to a greater extent in patients treated with ivabradine (ivabradine: 70.7 ± 9.4 vs. 58.8 ± 9.2, P < 0.001; bisoprolol: 65 ± 8.3 vs. 58.7 ± 8.2, P < 0.001). Accordingly, CFVR significantly increased in both groups (ivabradine 3.52 ± 0.64 vs. 2.67 ± 0.55, P < 0.001; bisoprolol 3.35 ± 0.70 vs. 2.72 ± 0.55, P < 0.001), but it was significantly higher in ivabradine group, despite a similar decrease in heart rate (63 ± 7 vs. 61 ± 6; P not significant).ConclusionIvabradine improves hyperemic peak CFV and CFVR to a greater extent than bisoprolol in patients with stable CAD, despite a similar decrease in heart rate. These data demonstrate that the benefits from ivabradine therapy go beyond the heart rate. This could be due to a different mechanism such as diastolic perfusion time, isovolumic ventricular relaxation, end-diastolic pressure, and collaterals.FundingServier.

Dataset Information

Noninvasive transthoracic doppler flow velocity and invasive thermodilution to assess coronary flow reserve.

Background

Methods

Results

Conclusions

Publications

Noninvasive transthoracic doppler flow velocity and invasive thermodilution to assess coronary flow reserve.

Similar Datasets

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