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The instantaneous hyperemic pressure-flow relationship in conscious humans

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Progress in quantitative coronary arteriography

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 155))

Summary

Background. The limitations and inaccuracies in the measurement of stenosis geometry, especially after coronary interventions, have prompted investigators to use functional indexes of stenosis severity, assessing the reduction of flow induced by the stenosis under study. Coronary flow reserve is greatly affected by the hemodynamic conditions at the time of the measurement and can not be applied for the immediate assessment of the results of coronary interventions.

Aim of the study. In this study the instantaneous relation between coronary flow velocity and pressure in the diastolic phase has been assessed during maximal hyperemia in normal or near-normal coronary arteries (<30% diameter stenosis) in 52 patients and in arteries with ≥30% diameter stenosis in 24 patients.

Methods. The instantaneous peak coronary flow velocity measured with a Doppler guidewire was plotted against the simultaneously measured proximal coronary pressure, recorded through the guiding catheter. The phase of progressive flow reduction in mid-late diastole was selected in 4 consecutive cardiac cycles at the maximal effect of 8–12.5 mg of papaverine intracoronary. To study the possibility to determine the zero-flow pressure from the intercept of the velocity-pressure relation on the pressure axis, a controlled diastolic cardiac arrest was induced by an intracoronary bolus injection of 3 mg of adenosine in 9 cardiac transplant recipients.

Results. The slope of the instantaneous hyperemic diastolic flow velocity-pressure relation (IHDVPS) could be assessed in 44/52 patients with <30% diameter stenosis (85%) and in 15/24 patients with ≥30% diameter stenosis (62%). The presence of a flat diastolic flow velocity curve precluded the assessment of the IHDVPS in the patients with the most severe stenoses. The measurement of IHDVPS was highly reproducible (interobserver difference =± 1%) and showed a moderate beat-to-beat variability (15 ± 7%) The IHDVPS showed no significant correlation with heart rate, mean diastolic aortic pressure, left ventricular +dP/dt, Vmax, -dP/dt and τ1, type of vessel studied and cross-sectional area at the site of the velocity recording. The IHDVPS was significantly lower in arteries with ≥30% diameter stenosis than in normal arteries (0.77 ± 0.52 versus 1.65 ± 0.71 cm s-1 mmHg-1, p<0.0001).

The study of the velocity-pressure relation during long diastolic pauses showed a curvilinear relation in the lower pressure range between velocity and pressure, with an upwards concavity to the velocity axis and no intercept with the pressure axis in most cases.

Conclusion, The instantaneous flow velocity-pressure relation during maximal hyperemia can be reliably assessed using intracoronary Doppler in the Catheterization Laboratory, has a low inter-observer variability and a moderate beat-to-beat variability, is independent from heart rate, aortic pressure or indexes of left ventricular contractility-relaxation at the time of the assessment. The slope of this relation can distinguish arteries with and without significant coronary stenoses, suggesting that this index is a potential alternative to coronary flow reserve for the assessment of stenosis severity before and after coronary interventions. The curvilinearity of the velocity-pressure relation during long diastolic pauses, possibly due to a significant reduction of luminal cross-sectional area at low pressures, precludes the use of the flow velocity-pressure relation for the assessment of the zero-flow pressure.

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References

  1. Reiber JHC, Serruys PW, Kooijman CJ et al. Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation 1985; 71: 280–288.

    Article  PubMed  CAS  Google Scholar 

  2. Tenaglia AN, Buller CE, Kisslo KB, Stack RS, Davidson CJ. Mechanisms of balloon angioplasty and directional coronary atherectomy as assessed by intravascular ultrasound. J Am Coll Cardiol 1992; 20: 685–691.

    Article  PubMed  CAS  Google Scholar 

  3. Young DF, Cholvin NR, Roth AC. Pressure drop across artificially induced stenoses in the femoral arteries of dogs. Circ Res 1975; 36: 735–743.

    Article  PubMed  CAS  Google Scholar 

  4. Lipscomb K, Hooten S. Effect of stenotic dimensions and blood flow on the hemodynamic significance of model coronary arterial stenoses. Am J Cardiol 1978; 42: 781–792.

    Article  PubMed  CAS  Google Scholar 

  5. Serruys PW, Reiber JHC, Wijns W et al. Assessment of percutaneous transluminal coronary angioplasty by quantitative coronary angiography: diameter versus densitometric area measurements. Am J Cardiol 1984; 54: 482–488.

    Article  PubMed  CAS  Google Scholar 

  6. Araujo LI, Lammertsma AA, Rhodes CG et al. Non-invasive quantification of regional myocardial blood flow in coronary artery disease with oxygen-15-labeled carbon dioxide inhalation and positron emission tomography. Circulation 1991; 83: 875–885.

    Article  PubMed  CAS  Google Scholar 

  7. Krivokapich J, Huang SC, Schelbert HR. Assessment of the effects of dobutamine on myocardial blood flow and oxidative metabolism in normal human subjects using nitrogen-13 ammonia and carbon-11 acetate. Am J Cardiol 1993; 71: 1351–1356.

    Article  PubMed  CAS  Google Scholar 

  8. Gould KL. Identifying and measuring severity of coronary artery stenosis. Quantitative coronary arteriography and positron emission tomography. Circulation 1988; 78: 237–245.

    Article  PubMed  CAS  Google Scholar 

  9. Gould KL, Lipscomb K, Hamilton GW. Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol 1974; 33: 87–94.

    Article  PubMed  CAS  Google Scholar 

  10. Klocke FJ. Measurements of coronary flow reserve: defining pathophysiology versus making decisions about patient care. Circulation 1987; 76: 1183–1189.

    Article  PubMed  CAS  Google Scholar 

  11. McGinn AL, White CW, Wilson RF. Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure and ventricular preload. Circulation 1990; 81: 1319–1330.

    Article  PubMed  CAS  Google Scholar 

  12. Rossen JD, Winniford MD. Effect of increases in heart rate and arterial pressure on coronary flow reserve in humans. J Am Coll Cardiol 1993; 21: 343–348.

    Article  PubMed  CAS  Google Scholar 

  13. Wilson RF, Marcus ML, White CW. Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. Circulation 1987; 75: 723–732.

    Article  PubMed  CAS  Google Scholar 

  14. Harrison DG, White CW, Hiratzka LF, Doty DB, Barnes DH et al. The value of lesion cross-sectional area determined by quantitative coronary angiography in assessing the physiologic significance of proximal left anterior descending coronary artery stenoses. Circulation 1984; 69: 1111–1119.

    Article  PubMed  CAS  Google Scholar 

  15. Zijlstra F, van Ommeren J, Reiber JHC, Serruys PW. Does the quantitative assessment of coronary artery dimensions predict the physiologic significance of a coronary stenosis? Circulation 1987; 75: 1154–1161.

    Article  PubMed  CAS  Google Scholar 

  16. Laarman GJ, Serruys PW, Suryapranata H et al. Inability of coronary flow reserve measurements to assess the efficacy of coronary angioplasty in the first 24 hours in unselected patients. Am Heart J 1991; 122: 631–639.

    Article  PubMed  CAS  Google Scholar 

  17. Wilson RF, Johnson MR, Marcus ML et al. The effect of coronary angioplasty on coronary flow reserve. Circulation 1988; 77: 873–885.

    Article  PubMed  CAS  Google Scholar 

  18. Serruys PW, Juilliere Y, Zijlstra F et al. Coronary blood flow velocity during percutaneous transluminal coronary angioplasty as a guide for assessment of the functional result. Am J Cardiol 1988; 61: 253–259.

    Article  PubMed  CAS  Google Scholar 

  19. Kern MJ, Deligonul U, Vandormael M et al. Impaired coronary vasodilator reserve in the immediate postcoronary angioplasty period: analysis of coronary artery flow velocity indexes and regional cardiac venous efflux. J Am Coll Cardiol 1989; 13: 860–872.

    Article  PubMed  CAS  Google Scholar 

  20. Segal J, Kern MJ, Scott NA et al. Alterations of phasic coronary artery flow velocity in humans during percutaneous coronary angioplasty. J Am Coll Cardiol 1992; 20: 276–286.

    Article  PubMed  CAS  Google Scholar 

  21. Ofili EO, Kern MJ, Labovitz AJ et al. Analysis of coronary blood flow velocity dynamics in angiographically normal and stenosed arteries before and after endolumen enlargement by angioplasty. J Am Coll Cardiol 1993; 21: 308–316.

    Article  PubMed  CAS  Google Scholar 

  22. Serruys PW, Di Mario C, Meneveau N et al. Intracoronary pressure and flow velocity from sensor tip guidewires: a new methodological approach for assessment of coronary hemodynamics before and after coronary interventions. Am J Cardiol 1993; 71: 41D–53D.

    Article  PubMed  CAS  Google Scholar 

  23. Uren NG, Crake T, Lefroy DC, de Silva R, Davies GJ, Maseri A. Delayed recovery of coronary resistive vessel function after coronary angioplasty. J Am Coll Cardiol 1993; 21: 612–621.

    Article  PubMed  CAS  Google Scholar 

  24. Mancini GBJ, McGillem MJ, DeBoe SF, Gallagher KP. The diastolic hyperemic flow versus pressure relation: a new index of coronary stenosis severity and flow reserve. Circulation 1989; 80: 941–950.

    Article  PubMed  CAS  Google Scholar 

  25. Mancini GBJ, Cleary RM, DeBoe SF, Moore NB, Gallagher KP. Instantaneous hyperemic flow-versus-pressure slope index. Microsphere validation of an alternative to measures of coronary reserve. Circulation 1991; 84: 862–870.

    Article  PubMed  CAS  Google Scholar 

  26. Cleary RM, Aron D, Moore NB, DeBoe SF, Mancini GBJ. Tachycardia, contractility and volume loading alter conventional indexes of coronary flow reserve, but not the instantenous hyperemic flow versus pressure slope index. J Am Coll Cardiol 1992; 20: 1261–1269.

    Article  PubMed  CAS  Google Scholar 

  27. Cleary RM, Moore NB, DeBoe SF, Mancini GBJ. Sensitivity and reproducibility of the instantaneous hyperemic flow versus pressure slope index compared to coronary flow reserve for the assessment of stenosis severity. Am Heart J 1993; 126: 57–65.

    Article  PubMed  CAS  Google Scholar 

  28. Doucette JW, Corl PD, Payne HM et al. Validation of a Doppler guide wire for intravascular measurement of coronary artery flow velocity. Circulation 1992; 85: 1899–1911.

    Article  PubMed  CAS  Google Scholar 

  29. Serruys PW, Di Mario C, Kern MJ. Intracoronary Doppler. In Topol EJ (ed): Textbook of interventional cardiology, 2nd ed. Philadelphia: Saunders 1993: 1069–1121.

    Google Scholar 

  30. Zijlstra F, Serruys PW, Hugenholtz PG. Papaverine: the ideal coronary vasodilator for investigating coronary flow reserve? A study of timing, magnitude, reproducibility and safety of the coronary hyperemic response after intracoronary papaverine. Cathet Cardio-vasc Diagn 1986; 12: 298–303.

    Article  CAS  Google Scholar 

  31. Serruys PW, Wijns W, van den Brand M et al. Left ventricular performance, regional blood flow, wall motion, and lactate metabolism during transluminal angioplasty. Circulation 1984; 70: 25–36.

    Article  PubMed  CAS  Google Scholar 

  32. Haase J, Di Mario C, Slager CJ, van der Giessen WJ, den Boer A, de Feyter PJ et al. In-vivo validation of on-line and off-line geometric coronary measurements using insertion of stenosis phantoms in porcine coronary arteries. Cathet Cardiovasc Diagn 1992; 27: 16–27.

    Article  PubMed  CAS  Google Scholar 

  33. Di Mario C, Roelandt JRTC, de Jaegere P, Linker DT, Oomen J, Serruys PW. Limitations of the zero-crossing detector in the analysis of intracoronary Doppler: a comparison with fast Fourier transform analysis of basal, hyperemic and transstenotic blood flow velocity measurements in patients with coronary artery disease. Cathet Cardiovasc Diagn 1992; 28: 56–64.

    Article  Google Scholar 

  34. Zar JH. Biostatistical Analysis, 2nd ed. Englewood Cliffs: Prentice Hall 1984.

    Google Scholar 

  35. Seiler C, Kirkeeide RL, Gould KL. Basic structure-function relations of the epicardial coronary vascular tree. Basis of quantitative coronary angiography for diffuse coronary artery disease. Circulation 1992; 85: 1987–2003.

    CAS  Google Scholar 

  36. Gould KL. Coronary Artery Stenosis. New York: Elsevier 1991: 41–52.

    Google Scholar 

  37. Di Mario C, de Feyter PJ, Slager CJ, de Jaegere P, Roelandt JRTC, Serruys PW. Intracoronary blood flow velocity and transstenotic pressure gradient using sensor-tip pressure and Doppler guidewires: a new technology for the assessment of stenosis severity in the catheterization laboratory. Cathet Cardiovasc Diagn 1993; 28: 311–319.

    Article  PubMed  Google Scholar 

  38. Bellamy RF. Diastolic coronary artery pressure-flow relation in the dog. Circ Res 1978; 43: 92–101.

    Article  PubMed  CAS  Google Scholar 

  39. Bellamy RF. Calculation of coronary vascular resistance. Cardiovasc Res 1980; 14: 261–269.

    Article  PubMed  CAS  Google Scholar 

  40. Chilian WM, Marcus ML. Coronary venous outflow persists after cessation of coronary arterial inflow. Am J Physiol 1984; 247: H984–H990.

    PubMed  CAS  Google Scholar 

  41. Eng C, Jentzer JH, Kirk ES. The effects of the coronary capacitance on the interpretation of diastolic pressure-flow relationships. Circ Res 1982; 50: 334–341.

    Article  PubMed  CAS  Google Scholar 

  42. Canty JM Jr, Klocke FJ, Mates RE. Characterization of capacitance-free pressure-flow relations during single diastoles in dogs using an RC model with pressure dependent parameters. Circ Res 1987; 60: 273–282.

    Article  PubMed  Google Scholar 

  43. Spaan JAE. Coronary diastolic pressure-flow relation and zero flow pressure explained on the basis of intramyocardial compliance. Circ Res 1985; 56: 293–309.

    Article  PubMed  CAS  Google Scholar 

  44. Hoffman JIE, Spaan JAE. Pressure-flow relations in coronary circulation. Physiol Rev 1990; 70: 331–390.

    PubMed  CAS  Google Scholar 

  45. Klocke FJ, Weinstein IR, Klocke JF et al. Zero-flow pressures and pressure-flow relationships during single long diastoles in the canine coronary bed before and during maximum vasodilatation. Limited influence of capacitative effects. J Clin Invest 1981; 68: 970–980.

    Article  PubMed  CAS  Google Scholar 

  46. Nichols WW, O’Rourke MF. In McDonald’s blood flow in arteries: theoretic, experimental and clinical principles, 3rd ed. London: Edward Arnold 1990: 77–124.

    Google Scholar 

  47. Sudhir K, MacGregor JS, Brzabant SD et al. Assessment of coronary conductance and resistance vessel reactivity in response to nitroglycerin, ergonovine and adenosine: in vivo studies with simultaneous intravascular two dimensional and Doppler ultrasound. J Am Coll Cardiol 1993; 21: 1261–1268.

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. Carlo Di Mario
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  2. Rob Krams
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  3. Robert Gil
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  4. Nicolas Meneveau
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  5. Patrick W. Serruys
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Editor information

Editors and Affiliations

  1. Laboratory for Clinical and Experimental Image Processing, Department of Diagnostic Radiology and Nuclear Medicine, University Hospital Leiden, The Netherlands

    Johan H. C. Reiber

  2. Catheterization Laboratory, Thorax Center, Erasmus University, Rotterdam, The Netherlands

    Patrick W. Serruys

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© 1994 Springer Science+Business Media Dordrecht

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Di Mario, C., Krams, R., Gil, R., Meneveau, N., Serruys, P.W. (1994). The instantaneous hyperemic pressure-flow relationship in conscious humans. In: Reiber, J.H.C., Serruys, P.W. (eds) Progress in quantitative coronary arteriography. Developments in Cardiovascular Medicine, vol 155. Springer, Dordrecht. https://doi.org/10.1007/978-94-011-1172-0_16

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  • DOI: https://doi.org/10.1007/978-94-011-1172-0_16

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-4511-7

  • Online ISBN: 978-94-011-1172-0

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