Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices

Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices

BACKGROUNDDetermining the functional significance of each individual coronary lesion in patients with serial coronary stenoses is challenging. It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary...

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Veröffentlicht in:Circulation. Cardiovascular interventions 2022-09, Vol.15 (9), p.e012134-e012134
Hauptverfasser: Ahn, Jung-Min, Nakayoshi, Takaharu, Hashikata, Takehiro, Kashiyama, Kuninobu, Arashi, Hiroyuki, Kweon, Jihoon, van’t Veer, Marcel, Lyons, Jennifer, Fearon, William F.
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container_issue 9
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container_title Circulation. Cardiovascular interventions
container_volume 15
creator Ahn, Jung-Min
Nakayoshi, Takaharu
Hashikata, Takehiro
Kashiyama, Kuninobu
Arashi, Hiroyuki
Kweon, Jihoon
van’t Veer, Marcel
Lyons, Jennifer
Fearon, William F.
description BACKGROUNDDetermining the functional significance of each individual coronary lesion in patients with serial coronary stenoses is challenging. It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary pressure (Pd/Pa) are more accurate than fractional flow reserve (FFR) because autoregulation should maintain stable resting coronary flow and avoid hemodynamic interdependence (cross-talk) that occurs during hyperemia. This study aimed to measure the degree of hemodynamic interdependence of iFR, resting Pd/Pa, and FFR in a porcine model of serial coronary stenosis. METHODSIn 6 anesthetized female swine, 381 serial coronary stenoses were created in the left anterior descending artery using 2 balloon catheters. The degree of hemodynamic interdependence was calculated by measuring the absolute changes in iFR, resting Pd/Pa, and FFR across the fixed stenosis as the severity of the other stenosis varied. RESULTSThe hemodynamic interdependence of iFR, resting Pd/Pa, and FFR was 0.039±0.048, 0.021±0.026, and 0.034±0.034, respectively (all P
doi_str_mv 10.1161/CIRCINTERVENTIONS.122.012134
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It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary pressure (Pd/Pa) are more accurate than fractional flow reserve (FFR) because autoregulation should maintain stable resting coronary flow and avoid hemodynamic interdependence (cross-talk) that occurs during hyperemia. This study aimed to measure the degree of hemodynamic interdependence of iFR, resting Pd/Pa, and FFR in a porcine model of serial coronary stenosis. METHODSIn 6 anesthetized female swine, 381 serial coronary stenoses were created in the left anterior descending artery using 2 balloon catheters. The degree of hemodynamic interdependence was calculated by measuring the absolute changes in iFR, resting Pd/Pa, and FFR across the fixed stenosis as the severity of the other stenosis varied. RESULTSThe hemodynamic interdependence of iFR, resting Pd/Pa, and FFR was 0.039±0.048, 0.021±0.026, and 0.034±0.034, respectively (all P&lt;0.001). When the functional significance of serial stenoses was less severe (0.70-0.90 for each index), the hemodynamic interdependence was 0.009±0.020, 0.007±0.013, and 0.017±0.022 for iFR, resting Pd/Pa, and FFR, respectively (all P&lt;0.001). However, in more severe serial coronary stenoses (&lt;0.60 for each index), hemodynamic interdependence was 0.060±0.050, 0.037±0.030, and 0.051±0.037 for iFR, resting Pd/Pa, and FFR, respectively (all P&lt;0.001). CONCLUSIONSWhen assessing serial coronary stenoses, nonhyperemic pressure ratios are affected by hemodynamic interdependence. When the functional significance of serial coronary stenoses is severe, the effect is similar to that which is seen with FFR.</description><identifier>ISSN: 1941-7632</identifier><identifier>ISSN: 1941-7640</identifier><identifier>EISSN: 1941-7632</identifier><identifier>DOI: 10.1161/CIRCINTERVENTIONS.122.012134</identifier><language>eng</language><publisher>Lippincott Williams &amp; Wilkins</publisher><ispartof>Circulation. Cardiovascular interventions, 2022-09, Vol.15 (9), p.e012134-e012134</ispartof><rights>Lippincott Williams &amp; Wilkins</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3996-c40df0fcb70393b8195217ad9208e78296d0652fd2cd2f11af4c46aa3f598273</citedby><cites>FETCH-LOGICAL-c3996-c40df0fcb70393b8195217ad9208e78296d0652fd2cd2f11af4c46aa3f598273</cites><orcidid>0000-0002-5340-8603 ; 0000-0001-9633-1303 ; 0000-0003-1799-1368 ; 0000-0003-4031-391X</orcidid></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></links><search><creatorcontrib>Ahn, Jung-Min</creatorcontrib><creatorcontrib>Nakayoshi, Takaharu</creatorcontrib><creatorcontrib>Hashikata, Takehiro</creatorcontrib><creatorcontrib>Kashiyama, Kuninobu</creatorcontrib><creatorcontrib>Arashi, Hiroyuki</creatorcontrib><creatorcontrib>Kweon, Jihoon</creatorcontrib><creatorcontrib>van’t Veer, Marcel</creatorcontrib><creatorcontrib>Lyons, Jennifer</creatorcontrib><creatorcontrib>Fearon, William F.</creatorcontrib><title>Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices</title><title>Circulation. Cardiovascular interventions</title><description>BACKGROUNDDetermining the functional significance of each individual coronary lesion in patients with serial coronary stenoses is challenging. It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary pressure (Pd/Pa) are more accurate than fractional flow reserve (FFR) because autoregulation should maintain stable resting coronary flow and avoid hemodynamic interdependence (cross-talk) that occurs during hyperemia. This study aimed to measure the degree of hemodynamic interdependence of iFR, resting Pd/Pa, and FFR in a porcine model of serial coronary stenosis. METHODSIn 6 anesthetized female swine, 381 serial coronary stenoses were created in the left anterior descending artery using 2 balloon catheters. The degree of hemodynamic interdependence was calculated by measuring the absolute changes in iFR, resting Pd/Pa, and FFR across the fixed stenosis as the severity of the other stenosis varied. RESULTSThe hemodynamic interdependence of iFR, resting Pd/Pa, and FFR was 0.039±0.048, 0.021±0.026, and 0.034±0.034, respectively (all P&lt;0.001). When the functional significance of serial stenoses was less severe (0.70-0.90 for each index), the hemodynamic interdependence was 0.009±0.020, 0.007±0.013, and 0.017±0.022 for iFR, resting Pd/Pa, and FFR, respectively (all P&lt;0.001). However, in more severe serial coronary stenoses (&lt;0.60 for each index), hemodynamic interdependence was 0.060±0.050, 0.037±0.030, and 0.051±0.037 for iFR, resting Pd/Pa, and FFR, respectively (all P&lt;0.001). CONCLUSIONSWhen assessing serial coronary stenoses, nonhyperemic pressure ratios are affected by hemodynamic interdependence. When the functional significance of serial coronary stenoses is severe, the effect is similar to that which is seen with FFR.</description><issn>1941-7632</issn><issn>1941-7640</issn><issn>1941-7632</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNplkE9LAzEQxYMoWKvfYQ8evGxNJvsv4EWWqivSSrv0GtJsYlfTTU22lH57IysoeBhmYN57PH4IXRM8ISQjt2W1KKtZPV2sprO6ms-WEwIwwQQITU7QiLCExHlG4fTPfY4uvH_HOJwZjNBztd0J2UdWR0vlWmGi0jrbCXeMlr3qrFc-sl20Eq61e__7fN0cfWuNfWtlVHVNK5W_RGdaGK-ufvYY1Q_TunyKX-aPVXn_EkvKWBbLBDcaa7nOMWV0XRCWAslFwwAXKi-AZQ3OUtANyAY0IUInMsmEoDplBeR0jG6G2J2zn3vle75tvVTGiE6FihxyEuxpSA_Su0EqnfXeKc13rt2G-pxg_k2Q_yPIA0E-EAz2ZLAfrOmV8x9mf1COb5Qw_SaIKM0TlsaAATDDGMdhAtcv9iF2Sw</recordid><startdate>20220901</startdate><enddate>20220901</enddate><creator>Ahn, Jung-Min</creator><creator>Nakayoshi, Takaharu</creator><creator>Hashikata, Takehiro</creator><creator>Kashiyama, Kuninobu</creator><creator>Arashi, Hiroyuki</creator><creator>Kweon, Jihoon</creator><creator>van’t Veer, Marcel</creator><creator>Lyons, Jennifer</creator><creator>Fearon, William F.</creator><general>Lippincott Williams &amp; Wilkins</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5340-8603</orcidid><orcidid>https://orcid.org/0000-0001-9633-1303</orcidid><orcidid>https://orcid.org/0000-0003-1799-1368</orcidid><orcidid>https://orcid.org/0000-0003-4031-391X</orcidid></search><sort><creationdate>20220901</creationdate><title>Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices</title><author>Ahn, Jung-Min ; Nakayoshi, Takaharu ; Hashikata, Takehiro ; Kashiyama, Kuninobu ; Arashi, Hiroyuki ; Kweon, Jihoon ; van’t Veer, Marcel ; Lyons, Jennifer ; Fearon, William F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3996-c40df0fcb70393b8195217ad9208e78296d0652fd2cd2f11af4c46aa3f598273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahn, Jung-Min</creatorcontrib><creatorcontrib>Nakayoshi, Takaharu</creatorcontrib><creatorcontrib>Hashikata, Takehiro</creatorcontrib><creatorcontrib>Kashiyama, Kuninobu</creatorcontrib><creatorcontrib>Arashi, Hiroyuki</creatorcontrib><creatorcontrib>Kweon, Jihoon</creatorcontrib><creatorcontrib>van’t Veer, Marcel</creatorcontrib><creatorcontrib>Lyons, Jennifer</creatorcontrib><creatorcontrib>Fearon, William F.</creatorcontrib><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>Ahn, Jung-Min</au><au>Nakayoshi, Takaharu</au><au>Hashikata, Takehiro</au><au>Kashiyama, Kuninobu</au><au>Arashi, Hiroyuki</au><au>Kweon, Jihoon</au><au>van’t Veer, Marcel</au><au>Lyons, Jennifer</au><au>Fearon, William F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices</atitle><jtitle>Circulation. Cardiovascular interventions</jtitle><date>2022-09-01</date><risdate>2022</risdate><volume>15</volume><issue>9</issue><spage>e012134</spage><epage>e012134</epage><pages>e012134-e012134</pages><issn>1941-7632</issn><issn>1941-7640</issn><eissn>1941-7632</eissn><abstract>BACKGROUNDDetermining the functional significance of each individual coronary lesion in patients with serial coronary stenoses is challenging. It has been proposed that nonhyperemic pressure ratios, such as the instantaneous wave free ratio (iFR) and the ratio of resting distal to proximal coronary pressure (Pd/Pa) are more accurate than fractional flow reserve (FFR) because autoregulation should maintain stable resting coronary flow and avoid hemodynamic interdependence (cross-talk) that occurs during hyperemia. This study aimed to measure the degree of hemodynamic interdependence of iFR, resting Pd/Pa, and FFR in a porcine model of serial coronary stenosis. METHODSIn 6 anesthetized female swine, 381 serial coronary stenoses were created in the left anterior descending artery using 2 balloon catheters. The degree of hemodynamic interdependence was calculated by measuring the absolute changes in iFR, resting Pd/Pa, and FFR across the fixed stenosis as the severity of the other stenosis varied. RESULTSThe hemodynamic interdependence of iFR, resting Pd/Pa, and FFR was 0.039±0.048, 0.021±0.026, and 0.034±0.034, respectively (all P&lt;0.001). When the functional significance of serial stenoses was less severe (0.70-0.90 for each index), the hemodynamic interdependence was 0.009±0.020, 0.007±0.013, and 0.017±0.022 for iFR, resting Pd/Pa, and FFR, respectively (all P&lt;0.001). However, in more severe serial coronary stenoses (&lt;0.60 for each index), hemodynamic interdependence was 0.060±0.050, 0.037±0.030, and 0.051±0.037 for iFR, resting Pd/Pa, and FFR, respectively (all P&lt;0.001). CONCLUSIONSWhen assessing serial coronary stenoses, nonhyperemic pressure ratios are affected by hemodynamic interdependence. When the functional significance of serial coronary stenoses is severe, the effect is similar to that which is seen with FFR.</abstract><pub>Lippincott Williams &amp; Wilkins</pub><doi>10.1161/CIRCINTERVENTIONS.122.012134</doi><orcidid>https://orcid.org/0000-0002-5340-8603</orcidid><orcidid>https://orcid.org/0000-0001-9633-1303</orcidid><orcidid>https://orcid.org/0000-0003-1799-1368</orcidid><orcidid>https://orcid.org/0000-0003-4031-391X</orcidid><oa>free_for_read</oa></addata></record>
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title Impact of Serial Coronary Stenoses on Various Coronary Physiologic Indices
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