Influence of increased heart rate and aortic pressure on resting indices of functional coronary stenosis severity
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Key result
Tachycardia induced by atrial pacing significantly decreased the resting distal-to-aortic pressure ratio (Pd/Pa) by 0.05 compared to baseline, causing 27% of borderline lesions to cross the diagnostic threshold.
Why the study?
Do changes in heart rate and aortic pressure affect resting indices of functional coronary stenosis severity in patients with stable coronary artery disease?
Population
15 patients with stable coronary artery disease and a single de novo lesion of intermediate severity…
Comparison
Hemodynamic provocations during cardiac… vs Baseline (control) resting conditions.
Design
Cohort
Authors
Discussion
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Implication
Heart rate changes may misclassify borderline lesions on resting Pd/Pa; leaves open need for rate-adjusted thresholds in prospective studies.
Study Design
Type
Observational (n=15)
Multicenter
No
Structured PICO
Do changes in heart rate and aortic pressure affect resting indices of functional coronary stenosis severity in patients with stable coronary artery disease?
P
Population
15 patients with stable coronary artery disease and a single de novo lesion of intermediate severity (32-74% diameter reduction, mean 55 ± 3%) scheduled for elective percutaneous coronary intervention. Mean age 57 ± 2, 87% male. Excluded: diffuse or three-vessel disease, ejection fraction <30%, recent myocardial infarction, serious valve abnormalities, prior cardiac surgery, hypertrophic cardiomyopathy, cardiac arrhythmia, abnormal clotting profiles, or severe renal failure.
I
Intervention
Hemodynamic provocations during cardiac catheterization: atrial pacing at 120 bpm, increased aortic pressure (+30 mmHg) with intravenous phenylephrine, and elevated aortic pressure while pacing at sinus heart rate.
C
Comparator
Baseline (control) resting conditions.
O
Outcome
Changes in baseline coronary hemodynamics and functional stenosis assessment indices (Pd/Pa, baseline microvascular resistance, and baseline stenosis resistance).surrogate
Main Result
Absolute Event Rate: 0.86% vs 0.91%
p-value: p=<0.01
Physiological changes in heart rate and aortic pressure significantly alter resting intracoronary hemodynamics, potentially causing misclassification of borderline coronary lesions when using resting indices like Pd/Pa.
Limitations
- Small cohort of patients limits extension of findings to a more general population
- Heterogeneous distribution of stenosis severities
- Intravenous phenylephrine may have stimulated alpha-1-adrenergic receptors in epicardial coronary vessels
- Confounding factors such as co-morbidities, medication, or microvascular disease may affect autoregulation
- Measured flow velocity rather than absolute volume flow
- Small cohort of patients
- Potential alpha-adrenergic coronary vasoconstriction from intravenous phenylephrine
- Confounding factors such as co-morbidities, medication, or microvascular disease
Cite This Study
Casadonte et al. (2017) conducted an observational in Stable coronary artery disease with a single de novo lesion (n=15). Hemodynamic provocation (atrial pacing and phenylephrine) vs. Baseline resting conditions was evaluated on Whole-cycle distal coronary-to-aortic pressure ratio (Pd/Pa) during atrial pacing (p=<0.01). Tachycardia induced by atrial pacing significantly decreased the resting distal-to-aortic pressure ratio (Pd/Pa) by 0.05 compared to baseline, causing 27% of borderline lesions to cross the diagnostic threshold.
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