Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve
BACKGROUND—The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially aff...
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| Veröffentlicht in: | Circulation. Cardiovascular interventions 2015-04, Vol.8 (4), p.e002219-e002219 |
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| container_title | Circulation. Cardiovascular interventions |
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| creator | Ladwiniec, Andrew Cunnington, Michael S Rossington, Jennifer Mather, Adam N Alahmar, Albert Oliver, Richard M Nijjer, Sukhjinder S Davies, Justin E Thackray, Simon Alamgir, Farquad Hoye, Angela |
| description | BACKGROUND—The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO.
METHODS AND RESULTS—In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity–pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product177.5 to 139.9 mL/min (difference −37.6 [−62.6 to −12.6]; P=0.005), mean decrease in hyperemic flow306.5 to 272.9 mL/min (difference, −33.5 [−58.7 to −8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity–pressure gradient relation (r=0.69; P |
| doi_str_mv | 10.1161/CIRCINTERVENTIONS.114.002219 |
| format | Article |
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METHODS AND RESULTS—In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity–pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product177.5 to 139.9 mL/min (difference −37.6 [−62.6 to −12.6]; P=0.005), mean decrease in hyperemic flow306.5 to 272.9 mL/min (difference, −33.5 [−58.7 to −8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity–pressure gradient relation (r=0.69; P<0.001).
CONCLUSIONS—Recanalization of a CTO results in a modest increase in the FFR of the predominant collateral donor vessel associated with a reduction in coronary flow. A larger increase in FFR is associated with greater coronary stenosis severity.</description><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.114.002219</identifier><identifier>PMID: 25805570</identifier><language>eng</language><publisher>United States: American Heart Association, Inc</publisher><subject>Aged ; Arteries - physiology ; Chronic Disease ; Collateral Circulation ; Coronary Occlusion - diagnosis ; Coronary Occlusion - surgery ; Female ; Fractional Flow Reserve, Myocardial ; Hemodynamics - physiology ; Humans ; Hyperemia - diagnosis ; Hyperemia - etiology ; Ischemia - diagnosis ; Ischemia - surgery ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Postoperative Complications - diagnosis ; Predictive Value of Tests ; Prognosis ; Tissue Donors</subject><ispartof>Circulation. Cardiovascular interventions, 2015-04, Vol.8 (4), p.e002219-e002219</ispartof><rights>2015 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4880-b4e9ebdec49e0b581e84787d2c3ead162b5e63c36367d41408e19a81358584e03</citedby><cites>FETCH-LOGICAL-c4880-b4e9ebdec49e0b581e84787d2c3ead162b5e63c36367d41408e19a81358584e03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25805570$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ladwiniec, Andrew</creatorcontrib><creatorcontrib>Cunnington, Michael S</creatorcontrib><creatorcontrib>Rossington, Jennifer</creatorcontrib><creatorcontrib>Mather, Adam N</creatorcontrib><creatorcontrib>Alahmar, Albert</creatorcontrib><creatorcontrib>Oliver, Richard M</creatorcontrib><creatorcontrib>Nijjer, Sukhjinder S</creatorcontrib><creatorcontrib>Davies, Justin E</creatorcontrib><creatorcontrib>Thackray, Simon</creatorcontrib><creatorcontrib>Alamgir, Farquad</creatorcontrib><creatorcontrib>Hoye, Angela</creatorcontrib><title>Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve</title><title>Circulation. Cardiovascular interventions</title><addtitle>Circ Cardiovasc Interv</addtitle><description>BACKGROUND—The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO.
METHODS AND RESULTS—In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity–pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product177.5 to 139.9 mL/min (difference −37.6 [−62.6 to −12.6]; P=0.005), mean decrease in hyperemic flow306.5 to 272.9 mL/min (difference, −33.5 [−58.7 to −8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity–pressure gradient relation (r=0.69; P<0.001).
CONCLUSIONS—Recanalization of a CTO results in a modest increase in the FFR of the predominant collateral donor vessel associated with a reduction in coronary flow. A larger increase in FFR is associated with greater coronary stenosis severity.</description><subject>Aged</subject><subject>Arteries - physiology</subject><subject>Chronic Disease</subject><subject>Collateral Circulation</subject><subject>Coronary Occlusion - diagnosis</subject><subject>Coronary Occlusion - surgery</subject><subject>Female</subject><subject>Fractional Flow Reserve, Myocardial</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Hyperemia - diagnosis</subject><subject>Hyperemia - etiology</subject><subject>Ischemia - diagnosis</subject><subject>Ischemia - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Percutaneous Coronary Intervention</subject><subject>Postoperative Complications - diagnosis</subject><subject>Predictive Value of Tests</subject><subject>Prognosis</subject><subject>Tissue Donors</subject><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNplkE2P0zAQhi0EYj_gLyAfOHDJMo4_4khcVqFlI61aVApXy3GmpODGi51Q9d9j1GUvSLY8fvW8M5qXkLcMbhhT7H3Tbpp2tV1svi1W23a9-pJlcQNQlqx-Ri5ZLVhRKV4-f6oFXJCrlH4AZFmVL8lFKTVIWcEl8U3w3k4YracfwxgivY35d6Kfh1PaBx--n6gdezoNSNtx52ccHdKwo5Y2Qwzj3tFtmLJ57Zyfs2Ok-SyjdVOus7704Ug3mDD-xlfkxc76hK8f32vydbnYNnfF_fpT29zeF05oDUUnsMauRydqhE5qhlpUuupLx9H2TJWdRMUdV1xVvWACNLLaasalllog8Gvy7tz3IYZfM6bJHPbJYV50xDAnw5RSdWZZndEPZ9TFkFLEnXmI-4ONJ8PA_M3b_Jd3loU5553tbx4nzd0B-yfzv4AzIM7AMfica_rp5yNGM6D102CAcV6JWhYlMAkCAIp8GfA_pR2OMQ</recordid><startdate>201504</startdate><enddate>201504</enddate><creator>Ladwiniec, Andrew</creator><creator>Cunnington, Michael S</creator><creator>Rossington, Jennifer</creator><creator>Mather, Adam N</creator><creator>Alahmar, Albert</creator><creator>Oliver, Richard M</creator><creator>Nijjer, Sukhjinder S</creator><creator>Davies, Justin E</creator><creator>Thackray, Simon</creator><creator>Alamgir, Farquad</creator><creator>Hoye, Angela</creator><general>American Heart Association, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201504</creationdate><title>Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve</title><author>Ladwiniec, Andrew ; Cunnington, Michael S ; Rossington, Jennifer ; Mather, Adam N ; Alahmar, Albert ; Oliver, Richard M ; Nijjer, Sukhjinder S ; Davies, Justin E ; Thackray, Simon ; Alamgir, Farquad ; Hoye, Angela</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4880-b4e9ebdec49e0b581e84787d2c3ead162b5e63c36367d41408e19a81358584e03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Arteries - physiology</topic><topic>Chronic Disease</topic><topic>Collateral Circulation</topic><topic>Coronary Occlusion - diagnosis</topic><topic>Coronary Occlusion - surgery</topic><topic>Female</topic><topic>Fractional Flow Reserve, Myocardial</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Hyperemia - diagnosis</topic><topic>Hyperemia - etiology</topic><topic>Ischemia - diagnosis</topic><topic>Ischemia - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Percutaneous Coronary Intervention</topic><topic>Postoperative Complications - diagnosis</topic><topic>Predictive Value of Tests</topic><topic>Prognosis</topic><topic>Tissue Donors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ladwiniec, Andrew</creatorcontrib><creatorcontrib>Cunnington, Michael S</creatorcontrib><creatorcontrib>Rossington, Jennifer</creatorcontrib><creatorcontrib>Mather, Adam N</creatorcontrib><creatorcontrib>Alahmar, Albert</creatorcontrib><creatorcontrib>Oliver, Richard M</creatorcontrib><creatorcontrib>Nijjer, Sukhjinder S</creatorcontrib><creatorcontrib>Davies, Justin E</creatorcontrib><creatorcontrib>Thackray, Simon</creatorcontrib><creatorcontrib>Alamgir, Farquad</creatorcontrib><creatorcontrib>Hoye, Angela</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ladwiniec, Andrew</au><au>Cunnington, Michael S</au><au>Rossington, Jennifer</au><au>Mather, Adam N</au><au>Alahmar, Albert</au><au>Oliver, Richard M</au><au>Nijjer, Sukhjinder S</au><au>Davies, Justin E</au><au>Thackray, Simon</au><au>Alamgir, Farquad</au><au>Hoye, Angela</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><addtitle>Circ Cardiovasc Interv</addtitle><date>2015-04</date><risdate>2015</risdate><volume>8</volume><issue>4</issue><spage>e002219</spage><epage>e002219</epage><pages>e002219-e002219</pages><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract>BACKGROUND—The presence of a concomitant chronic total coronary occlusion (CTO) and a large collateral contribution might alter the fractional flow reserve (FFR) of an interrogated vessel, rendering the FFR unreliable at predicting ischemia should the CTO vessel be revascularized and potentially affecting the decision on optimal revascularization strategy. We tested the hypothesis that donor vessel FFR would significantly change after percutaneous coronary intervention of a concomitant CTO.
METHODS AND RESULTS—In consecutive patients undergoing percutaneous coronary intervention of a CTO, coronary pressure and flow velocity were measured at baseline and hyperemia in proximal and distal segments of both nontarget vessels, before and after percutaneous coronary intervention. Hemodynamics including FFR, absolute coronary flow, and the coronary flow velocity–pressure gradient relation were calculated. After successful percutaneous coronary intervention in 34 of 46 patients, FFR in the predominant donor vessel increased from 0.782 to 0.810 (difference, 0.028 [0.012 to 0.044]; P=0.001). Mean decrease in baseline donor vessel absolute flow adjusted for rate pressure product177.5 to 139.9 mL/min (difference −37.6 [−62.6 to −12.6]; P=0.005), mean decrease in hyperemic flow306.5 to 272.9 mL/min (difference, −33.5 [−58.7 to −8.3]; P=0.011). Change in predominant donor vessel FFR correlated with angiographic (%) diameter stenosis severity (r=0.44; P=0.009) and was strongly related to stenosis severity measured by the coronary flow velocity–pressure gradient relation (r=0.69; P<0.001).
CONCLUSIONS—Recanalization of a CTO results in a modest increase in the FFR of the predominant collateral donor vessel associated with a reduction in coronary flow. A larger increase in FFR is associated with greater coronary stenosis severity.</abstract><cop>United States</cop><pub>American Heart Association, Inc</pub><pmid>25805570</pmid><doi>10.1161/CIRCINTERVENTIONS.114.002219</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1941-7640 |
| ispartof | Circulation. Cardiovascular interventions, 2015-04, Vol.8 (4), p.e002219-e002219 |
| issn | 1941-7640 1941-7632 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Aged Arteries - physiology Chronic Disease Collateral Circulation Coronary Occlusion - diagnosis Coronary Occlusion - surgery Female Fractional Flow Reserve, Myocardial Hemodynamics - physiology Humans Hyperemia - diagnosis Hyperemia - etiology Ischemia - diagnosis Ischemia - surgery Male Middle Aged Percutaneous Coronary Intervention Postoperative Complications - diagnosis Predictive Value of Tests Prognosis Tissue Donors |
| title | Collateral Donor Artery Physiology and the Influence of a Chronic Total Occlusion on Fractional Flow Reserve |
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