Assessment of Microcirculatory Remodeling With Intracoronary Flow Velocity and Pressure Measurements: Validation With Endomyocardial Sampling in Cardiac Allografts
Intracoronary physiology techniques have been validated extensively for the assessment of epicardial stenoses but not for the lone study of coronary microcirculation. We performed a comparison between 4 intracoronary physiological indices with the actual structural microcirculatory changes documente...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2009-10, Vol.120 (16), p.1561-1568 |
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| creator | ESCANED, Javier FLORES, Alex JIMENEZ-QUEVEDO, Pilar BANUELOS, Camino ALONSO-PULPON, Luis MACAYA, Carlos GARCIA-PAVIA, Pablo SEGOVIA, Javier JIMENEZ, Jesús ARAGONCILLO, Paloma SALAS, Clara ALFONSO, Fernando HERNANDEZ, Rosana ANGIOLILLO, Dominick J |
| description | Intracoronary physiology techniques have been validated extensively for the assessment of epicardial stenoses but not for the lone study of coronary microcirculation. We performed a comparison between 4 intracoronary physiological indices with the actual structural microcirculatory changes documented in transplanted hearts.
In 17 cardiac allograft patients without coronary stenoses, ECG, intracoronary Doppler flow velocity, and aortic pressure were digitally recorded before and during maximal hyperemia with a dedicated system. Postprocessing of data yielded 4 indices of microcirculatory status: coronary flow velocity reserve (2.13+/-0.59), instantaneous hyperemic diastolic velocity pressure slope (2.33+/-1.25 cm x s x (-1)mm Hg(-1)), coronary resistance index (1.65+/-0.88 mm Hg x cm(-1) x s(-1)), and coronary resistance reserve (2.36+/-0.65). Quantitative morphometry was performed in endomyocardial biopsies during the same hospital intake; arteriolar obliteration (76.57+/-6.95%) and density (2.00+/-1.22 arterioles per 1 mm(2)) and capillary density (645+/-179 capillaries per 1 mm(2)) were measured. Univariate regression analysis between intracoronary measurements and histological findings revealed that instantaneous hyperemic diastolic velocity-pressure slope correlated with arteriolar obliteration (r=0.58, P=0.014) and capillary density (r=0.60, P=0.012). Statistical adjustment revealed an independent contribution of arteriolar obliteration (beta=0.61, P=0.0009) and capillary density (beta=-0.60, P=0.0008) to instantaneous hyperemic diastolic velocity-pressure slope values, resulting in an excellent predictive model (r=0.84, P=0.0002). Coronary resistance index correlated only with capillary density (r=0.70, P=0.019). Relative indices (coronary flow velocity reserve and coronary resistance reserve) did not correlate significantly with arteriolar obliteration, capillary density, or arteriolar density.
Intracoronary indices derived from pressure and flow, particularly instantaneous hyperemic diastolic velocity-pressure slope, appear to be superior to coronary flow velocity reserve in detecting structural microcirculatory changes. Both arteriolar obliteration and capillary rarefaction seem to influence microcirculatory hemodynamics independently. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.108.834739 |
| format | Article |
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In 17 cardiac allograft patients without coronary stenoses, ECG, intracoronary Doppler flow velocity, and aortic pressure were digitally recorded before and during maximal hyperemia with a dedicated system. Postprocessing of data yielded 4 indices of microcirculatory status: coronary flow velocity reserve (2.13+/-0.59), instantaneous hyperemic diastolic velocity pressure slope (2.33+/-1.25 cm x s x (-1)mm Hg(-1)), coronary resistance index (1.65+/-0.88 mm Hg x cm(-1) x s(-1)), and coronary resistance reserve (2.36+/-0.65). Quantitative morphometry was performed in endomyocardial biopsies during the same hospital intake; arteriolar obliteration (76.57+/-6.95%) and density (2.00+/-1.22 arterioles per 1 mm(2)) and capillary density (645+/-179 capillaries per 1 mm(2)) were measured. Univariate regression analysis between intracoronary measurements and histological findings revealed that instantaneous hyperemic diastolic velocity-pressure slope correlated with arteriolar obliteration (r=0.58, P=0.014) and capillary density (r=0.60, P=0.012). Statistical adjustment revealed an independent contribution of arteriolar obliteration (beta=0.61, P=0.0009) and capillary density (beta=-0.60, P=0.0008) to instantaneous hyperemic diastolic velocity-pressure slope values, resulting in an excellent predictive model (r=0.84, P=0.0002). Coronary resistance index correlated only with capillary density (r=0.70, P=0.019). Relative indices (coronary flow velocity reserve and coronary resistance reserve) did not correlate significantly with arteriolar obliteration, capillary density, or arteriolar density.
Intracoronary indices derived from pressure and flow, particularly instantaneous hyperemic diastolic velocity-pressure slope, appear to be superior to coronary flow velocity reserve in detecting structural microcirculatory changes. Both arteriolar obliteration and capillary rarefaction seem to influence microcirculatory hemodynamics independently.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.108.834739</identifier><identifier>PMID: 19805652</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Arterioles - pathology ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Flow Velocity ; Blood Pressure ; Brain ; Capillaries - pathology ; Cardiology. Vascular system ; Coronary Circulation ; Diastole ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Endocardium - pathology ; Female ; Heart Transplantation ; Humans ; Hyperemia - physiopathology ; Investigative techniques of hemodynamics ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Microvessels - physiopathology ; Middle Aged ; Myocardium - pathology ; Predictive Value of Tests ; Transplantation, Homologous ; Vascular Resistance ; Young Adult</subject><ispartof>Circulation (New York, N.Y.), 2009-10, Vol.120 (16), p.1561-1568</ispartof><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c332t-19a44148ea2ad56d86d753c29346f0e6ceeab18203538c2502ee0b41cb9401063</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22063431$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19805652$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ESCANED, Javier</creatorcontrib><creatorcontrib>FLORES, Alex</creatorcontrib><creatorcontrib>JIMENEZ-QUEVEDO, Pilar</creatorcontrib><creatorcontrib>BANUELOS, Camino</creatorcontrib><creatorcontrib>ALONSO-PULPON, Luis</creatorcontrib><creatorcontrib>MACAYA, Carlos</creatorcontrib><creatorcontrib>GARCIA-PAVIA, Pablo</creatorcontrib><creatorcontrib>SEGOVIA, Javier</creatorcontrib><creatorcontrib>JIMENEZ, Jesús</creatorcontrib><creatorcontrib>ARAGONCILLO, Paloma</creatorcontrib><creatorcontrib>SALAS, Clara</creatorcontrib><creatorcontrib>ALFONSO, Fernando</creatorcontrib><creatorcontrib>HERNANDEZ, Rosana</creatorcontrib><creatorcontrib>ANGIOLILLO, Dominick J</creatorcontrib><title>Assessment of Microcirculatory Remodeling With Intracoronary Flow Velocity and Pressure Measurements: Validation With Endomyocardial Sampling in Cardiac Allografts</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Intracoronary physiology techniques have been validated extensively for the assessment of epicardial stenoses but not for the lone study of coronary microcirculation. We performed a comparison between 4 intracoronary physiological indices with the actual structural microcirculatory changes documented in transplanted hearts.
In 17 cardiac allograft patients without coronary stenoses, ECG, intracoronary Doppler flow velocity, and aortic pressure were digitally recorded before and during maximal hyperemia with a dedicated system. Postprocessing of data yielded 4 indices of microcirculatory status: coronary flow velocity reserve (2.13+/-0.59), instantaneous hyperemic diastolic velocity pressure slope (2.33+/-1.25 cm x s x (-1)mm Hg(-1)), coronary resistance index (1.65+/-0.88 mm Hg x cm(-1) x s(-1)), and coronary resistance reserve (2.36+/-0.65). Quantitative morphometry was performed in endomyocardial biopsies during the same hospital intake; arteriolar obliteration (76.57+/-6.95%) and density (2.00+/-1.22 arterioles per 1 mm(2)) and capillary density (645+/-179 capillaries per 1 mm(2)) were measured. Univariate regression analysis between intracoronary measurements and histological findings revealed that instantaneous hyperemic diastolic velocity-pressure slope correlated with arteriolar obliteration (r=0.58, P=0.014) and capillary density (r=0.60, P=0.012). Statistical adjustment revealed an independent contribution of arteriolar obliteration (beta=0.61, P=0.0009) and capillary density (beta=-0.60, P=0.0008) to instantaneous hyperemic diastolic velocity-pressure slope values, resulting in an excellent predictive model (r=0.84, P=0.0002). Coronary resistance index correlated only with capillary density (r=0.70, P=0.019). Relative indices (coronary flow velocity reserve and coronary resistance reserve) did not correlate significantly with arteriolar obliteration, capillary density, or arteriolar density.
Intracoronary indices derived from pressure and flow, particularly instantaneous hyperemic diastolic velocity-pressure slope, appear to be superior to coronary flow velocity reserve in detecting structural microcirculatory changes. Both arteriolar obliteration and capillary rarefaction seem to influence microcirculatory hemodynamics independently.</description><subject>Adult</subject><subject>Arterioles - pathology</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Flow Velocity</subject><subject>Blood Pressure</subject><subject>Brain</subject><subject>Capillaries - pathology</subject><subject>Cardiology. Vascular system</subject><subject>Coronary Circulation</subject><subject>Diastole</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Endocardium - pathology</subject><subject>Female</subject><subject>Heart Transplantation</subject><subject>Humans</subject><subject>Hyperemia - physiopathology</subject><subject>Investigative techniques of hemodynamics</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microvessels - physiopathology</subject><subject>Middle Aged</subject><subject>Myocardium - pathology</subject><subject>Predictive Value of Tests</subject><subject>Transplantation, Homologous</subject><subject>Vascular Resistance</subject><subject>Young Adult</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUctu2zAQJIoWiZvkFwr20N7k8iWa6k0QksaA0xR59SisKSplQZEOKaHw9-RHQ8dGi54Wuzszu5hB6CMlc0ol_dIsb5r7VX23vP5eX9ZzStRccbHg1Rs0oyUThSh59RbNCCFVseCMHaP3Kf3OreSL8ggd00qRUpZshp7rlExKg_EjDj2-sjoGbaOeHIwhbvGNGUJnnPWP-Kcdf-GlHyPoEIOHvL1w4Q9-MC5Txi0G3-EfMatN0eArA7u6E05f8QM428Fog9_LnPsuDNugIXYWHL6FYfN6w3rcvM40rp0LjxH6MZ2idz24ZM4O9QTdX5zfNZfF6vrbsqlXheacjQWtQAgqlAEGXSk7JbtFyTWruJA9MVIbA2uqGOElV5qVhBlD1oLqdSUIzdacoM973U0MT5NJYzvYpI1z4E2YUiul5EpJnoHVHpjNSimavt1EO2RDWkraXULt_wnlsWr3CWXuh8ORaT2Y7h_zEEkGfDoAIGlwfQSvbfqLYyx_KjjlL9ltnuw</recordid><startdate>20091020</startdate><enddate>20091020</enddate><creator>ESCANED, Javier</creator><creator>FLORES, Alex</creator><creator>JIMENEZ-QUEVEDO, Pilar</creator><creator>BANUELOS, Camino</creator><creator>ALONSO-PULPON, Luis</creator><creator>MACAYA, Carlos</creator><creator>GARCIA-PAVIA, Pablo</creator><creator>SEGOVIA, Javier</creator><creator>JIMENEZ, Jesús</creator><creator>ARAGONCILLO, Paloma</creator><creator>SALAS, Clara</creator><creator>ALFONSO, Fernando</creator><creator>HERNANDEZ, Rosana</creator><creator>ANGIOLILLO, Dominick J</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><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>20091020</creationdate><title>Assessment of Microcirculatory Remodeling With Intracoronary Flow Velocity and Pressure Measurements: Validation With Endomyocardial Sampling in Cardiac Allografts</title><author>ESCANED, Javier ; FLORES, Alex ; JIMENEZ-QUEVEDO, Pilar ; BANUELOS, Camino ; ALONSO-PULPON, Luis ; MACAYA, Carlos ; GARCIA-PAVIA, Pablo ; SEGOVIA, Javier ; JIMENEZ, Jesús ; ARAGONCILLO, Paloma ; SALAS, Clara ; ALFONSO, Fernando ; HERNANDEZ, Rosana ; ANGIOLILLO, Dominick J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c332t-19a44148ea2ad56d86d753c29346f0e6ceeab18203538c2502ee0b41cb9401063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult</topic><topic>Arterioles - pathology</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Flow Velocity</topic><topic>Blood Pressure</topic><topic>Brain</topic><topic>Capillaries - pathology</topic><topic>Cardiology. Vascular system</topic><topic>Coronary Circulation</topic><topic>Diastole</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Endocardium - pathology</topic><topic>Female</topic><topic>Heart Transplantation</topic><topic>Humans</topic><topic>Hyperemia - physiopathology</topic><topic>Investigative techniques of hemodynamics</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microvessels - physiopathology</topic><topic>Middle Aged</topic><topic>Myocardium - pathology</topic><topic>Predictive Value of Tests</topic><topic>Transplantation, Homologous</topic><topic>Vascular Resistance</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ESCANED, Javier</creatorcontrib><creatorcontrib>FLORES, Alex</creatorcontrib><creatorcontrib>JIMENEZ-QUEVEDO, Pilar</creatorcontrib><creatorcontrib>BANUELOS, Camino</creatorcontrib><creatorcontrib>ALONSO-PULPON, Luis</creatorcontrib><creatorcontrib>MACAYA, Carlos</creatorcontrib><creatorcontrib>GARCIA-PAVIA, Pablo</creatorcontrib><creatorcontrib>SEGOVIA, Javier</creatorcontrib><creatorcontrib>JIMENEZ, Jesús</creatorcontrib><creatorcontrib>ARAGONCILLO, Paloma</creatorcontrib><creatorcontrib>SALAS, Clara</creatorcontrib><creatorcontrib>ALFONSO, Fernando</creatorcontrib><creatorcontrib>HERNANDEZ, Rosana</creatorcontrib><creatorcontrib>ANGIOLILLO, Dominick J</creatorcontrib><collection>Pascal-Francis</collection><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 (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>ESCANED, Javier</au><au>FLORES, Alex</au><au>JIMENEZ-QUEVEDO, Pilar</au><au>BANUELOS, Camino</au><au>ALONSO-PULPON, Luis</au><au>MACAYA, Carlos</au><au>GARCIA-PAVIA, Pablo</au><au>SEGOVIA, Javier</au><au>JIMENEZ, Jesús</au><au>ARAGONCILLO, Paloma</au><au>SALAS, Clara</au><au>ALFONSO, Fernando</au><au>HERNANDEZ, Rosana</au><au>ANGIOLILLO, Dominick J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of Microcirculatory Remodeling With Intracoronary Flow Velocity and Pressure Measurements: Validation With Endomyocardial Sampling in Cardiac Allografts</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2009-10-20</date><risdate>2009</risdate><volume>120</volume><issue>16</issue><spage>1561</spage><epage>1568</epage><pages>1561-1568</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Intracoronary physiology techniques have been validated extensively for the assessment of epicardial stenoses but not for the lone study of coronary microcirculation. We performed a comparison between 4 intracoronary physiological indices with the actual structural microcirculatory changes documented in transplanted hearts.
In 17 cardiac allograft patients without coronary stenoses, ECG, intracoronary Doppler flow velocity, and aortic pressure were digitally recorded before and during maximal hyperemia with a dedicated system. Postprocessing of data yielded 4 indices of microcirculatory status: coronary flow velocity reserve (2.13+/-0.59), instantaneous hyperemic diastolic velocity pressure slope (2.33+/-1.25 cm x s x (-1)mm Hg(-1)), coronary resistance index (1.65+/-0.88 mm Hg x cm(-1) x s(-1)), and coronary resistance reserve (2.36+/-0.65). Quantitative morphometry was performed in endomyocardial biopsies during the same hospital intake; arteriolar obliteration (76.57+/-6.95%) and density (2.00+/-1.22 arterioles per 1 mm(2)) and capillary density (645+/-179 capillaries per 1 mm(2)) were measured. Univariate regression analysis between intracoronary measurements and histological findings revealed that instantaneous hyperemic diastolic velocity-pressure slope correlated with arteriolar obliteration (r=0.58, P=0.014) and capillary density (r=0.60, P=0.012). Statistical adjustment revealed an independent contribution of arteriolar obliteration (beta=0.61, P=0.0009) and capillary density (beta=-0.60, P=0.0008) to instantaneous hyperemic diastolic velocity-pressure slope values, resulting in an excellent predictive model (r=0.84, P=0.0002). Coronary resistance index correlated only with capillary density (r=0.70, P=0.019). Relative indices (coronary flow velocity reserve and coronary resistance reserve) did not correlate significantly with arteriolar obliteration, capillary density, or arteriolar density.
Intracoronary indices derived from pressure and flow, particularly instantaneous hyperemic diastolic velocity-pressure slope, appear to be superior to coronary flow velocity reserve in detecting structural microcirculatory changes. Both arteriolar obliteration and capillary rarefaction seem to influence microcirculatory hemodynamics independently.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>19805652</pmid><doi>10.1161/CIRCULATIONAHA.108.834739</doi><tpages>8</tpages></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2009-10, Vol.120 (16), p.1561-1568 |
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| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Adult Arterioles - pathology Biological and medical sciences Blood and lymphatic vessels Blood Flow Velocity Blood Pressure Brain Capillaries - pathology Cardiology. Vascular system Coronary Circulation Diastole Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Endocardium - pathology Female Heart Transplantation Humans Hyperemia - physiopathology Investigative techniques of hemodynamics Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Microvessels - physiopathology Middle Aged Myocardium - pathology Predictive Value of Tests Transplantation, Homologous Vascular Resistance Young Adult |
| title | Assessment of Microcirculatory Remodeling With Intracoronary Flow Velocity and Pressure Measurements: Validation With Endomyocardial Sampling in Cardiac Allografts |
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