Key result
Intracoronary flow velocity correlates strongly with pressure measurements for assessing collateral circulation during PTCA.
Why the study?
Qualitative methods have been available to assess the human coronary collateral circulation, limiting conclusive investigation of therapies to promote collateral development.
Do intracoronary flow velocity or pressure measurements accurately quantify coronary collateral circulation compared to conventional ECG methods in patients undergoing PTCA?
Observational (n=51)
Do intracoronary flow velocity or pressure measurements accurately quantify coronary collateral circulation compared to conventional ECG methods in patients undergoing PTCA?
Effect estimate: r=0.80
p-value: p=0.0001
Intracoronary flow velocity and pressure measurements during PTCA provide an accurate, quantitative method for assessing coronary collateral circulation.
OBJECTIVES: This study evaluated two methods for the quantitative measurement of collaterals using intracoronary (IC) blood flow velocity or pressure measurements. BACKGROUND: The extent of myocardial necrosis after coronary artery occlusion is substantially influenced by the collateral circulation. So far, qualitative methods have been available to assess the human coronary collateral circulation, thus restraining the conclusive investigation of, for example, therapies to promote collateral development. METHODS: Fifty-one patients with a coronary artery stenosis to be treated by percutaneous transluminal coronary angioplasty (PTCA) were investigated using IC PTCA guidewire-based Doppler and pressure sensors positioned distal to the stenosis. Simultaneous measurements of aortic pressure, IC velocity and pressure distal to the stenosis during and after PTCA provided the variables for calculating collateral flow indices (CFIv and CFIp) that express collateral flow as a fraction of flow via the patent vessel. Both CFIv and CFIp were compared with conventional methods for collateral assessment, among them ST-segment changes >1 mm on IC and surface electrocardiogram (ECG) at PTCA. Also, CFIv and CFIp were compared with each other. RESULTS: In 11 patients without ECG signs of ischemia during PTCA (sufficient collaterals), relative collateral flow amounted to 46% as determined by Doppler and pressure wire. Patients with insufficient collaterals (n=40) had relative collateral flow values of 18%. Using a threshold of CFI=30%, sufficient and insufficient collaterals could be diagnosed with 100% sensitivity and 93% specificity by IC Doppler, and 75% sensitivity and 92% specificity by IC pressure measurements. The agreement between Doppler and pressure measurements was good: CFIv=0.08 + 0.8 CFIp, r=0.80, p=0.0001. CONCLUSIONS: Intracoronary flow velocity or pressure measurements during routine PTCA represent an accurate and, at last, quantitative method for assessing the coronary collateral circulation in humans.
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Seiler et al. (1998) conducted an observational in Coronary artery disease (n=51). Intracoronary flow velocity and pressure measurements vs. Conventional methods (ST-segment changes >1 mm on ECG) was evaluated on Agreement between Doppler and pressure measurements for collateral flow indices (r=0.80, p=0.0001). Intracoronary flow velocity and pressure measurements during PTCA accurately quantified coronary collateral circulation, demonstrating good agreement with each other (r=0.80, p=0.0001).
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