June 1, 1996Catheterization and Cardiovascular Diagnosis31 citations
Utilization of translesional hemodynamics: Comparison of pressure and flow methods in stenosis assessment in patients with coronary artery disease
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Key Result
The instantaneous relationship between pressure gradient and flow velocity accurately characterized stenosis hemodynamics, yielding reliable measurements in 11 of 21 patients.
Study Design
Type
Observational (n=21)
Structured PICO
Does the slope of the instantaneous transstenotic pressure gradient/velocity relationship accurately characterize stenosis severity in patients undergoing percutaneous revascularization?
P
Population
21 patients with coronary artery disease scheduled for percutaneous revascularization procedures
I
Intervention
Simultaneous measurement of poststenotic coronary pressure and flow velocity in basal condition and during maximal hyperemia induced with intracoronary papaverine to calculate the slope of the instantaneous transstenotic pressure gradient/velocity relationship
C
Comparator
Coronary flow reserve, maximal hyperemic velocity, stenosis flow reserve derived from quantitative angiography, basal and hyperemic transstenotic pressure gradient, and fractional flow reserve
O
Outcome
Feasibility and clinical usefulness of the slope of the instantaneous transstenotic pressure gradient/velocity relationshipsurrogate
The instantaneous relationship between pressure gradient and flow velocity changes during the cardiac cycle may accurately characterize stenosis hemodynamics in the catheterization laboratory.
Limitations
- Small sample size
- Pilot study
- Reliable measurements obtained in only 11 of 21 patients
Abstract
Aim of this study is the assessment of feasibility and clinical usefulness of a new index of stenosis severity, the slope of the instantaneous transstenotic pressure gradient/velocity relationship. Twenty-one patients scheduled for percutaneous revascularization procedures were studied with simultaneous measurement of poststenotic coronary pressure and flow velocity, in basal condition and during maximal hyperemia induced with intracoronary papaverine. Reliable measurements of the transstenotic pressure gradient/velocity relationship could be obtained in 11 patients. In 64% of the cases, a quadratic equation showed the best fit for the data. Steeper increases of the transstenotic pressure gradient at any given velocity increase were observed in the lesions with the smallest cross-sectional area measured with quantitative angiography. A comparison of this new index with coronary flow reserved, maximal hyperemic velocity, stenosis flow reserve derived from quantitative angiography, basal and hyperemic transstenotic pressure gradient and fractional flow reserve is presented and the relative merits of all these parameters are discussed. This pilot experience suggests that the instantaneous relationship between pressure gradient and flow velocity changes during the cardiac cycle can accurately characterize the stenosis hemodynamics in the catheterization laboratory.
Cite This Study
Mario et al. (1996) conducted an observational in Coronary artery disease (n=21). Simultaneous measurement of poststenotic coronary pressure and flow velocity vs. Other hemodynamic indices (e.g., fractional flow reserve, coronary flow reserve) was evaluated on Feasibility and clinical usefulness of the slope of the instantaneous transstenotic pressure gradient/velocity relationship. The instantaneous relationship between pressure gradient and flow velocity accurately characterized stenosis hemodynamics, yielding reliable measurements in 11 of 21 patients.