Impact of coronary revascularization on coronary flow capacity measured by transthoracic Doppler echocardiography in patients with chronic coronary syndrome

Figures

• 

  Fig. 1. STDE-derived CFC categorization. The distribution of 148 LAD vessels across the two-dimensional map of hyperemic DPV (x-axis) and CFVR (y-axis) with four categories. (A) Pre-PCI CFC categorization. A total of 27 (18.2%, A1), 42 (28.4%, A2), 43 (29.1%, A3), and 36 (24.3%, A4) vessels were categorized as severely reduced, moderately reduced, mildly reduced, and normal STDE-derived CFC, respectively. (B) Post-PCI CFC categorization. A total of 7 (4.7%, B1), 22 (14.9%, B2), 41 (27.7%, B3), and 78 (52.7%, B4) vessels were categorized as severely reduced, moderately reduced, mildly reduced, and normal STDE-derived CFC, respectively. CFC, coronary flow capacity, CFVR, coronary flow velocity reserve; LAD, left anterior descending artery; STDE, stress transthoracic Doppler echocardiography; PCI, percutaneous coronary flow intervention; DPV, diastolic peak velocity.

• 

  Fig. 2. Study flow chart. CCS, chronic coronary syndrome; FFR, fractional flow reserve; LAD, left anterior descending artery; STDE, stress transthoracic Doppler echocardiography; PCI, percutaneous coronary intervention.

• 

  Fig. 3. Changes in STDE-CFC status following PCI. Changes in STDE-CFC following PCI in the current population. The plot visualizes the number of vessels regarding pre-PCI STDE-CFC and post-PCI STDE-CFC. Numbers indicate the number of vessels corresponding to the STDE-CFC changes, illustrated as the lines. Thickness of the lines reflects the number of vessels in each STDE-CFC change. The majority of the vessels improved their STDE-CFC status, while 15.5% (23/148) of patients showed worsened status. CFC, coronary flow capacity; STDE, stress transthoracic Doppler echocardiography; PCI, percutaneous coronary intervention.

• 

  Fig. 4. Relationship between each physiologic parameter and the degree of hyperemic DPV increase. Scatterplots show inverse relationships between pre-PCI FFR (A), basal Pd/Pa (B), CFR (C), CFVR (D), hyperemic DPV (E). Boxplots show a graded degree of hyperemic DPV increase among STDE-derived CFC categories. CFC, coronary flow capacity; CFR, coronary flow reserve; CFVR, coronary flow velocity reserve; FFR, fractional flow reserve; DPV, diastolic peak velocity; STDE, stress transthoracic Doppler echocardiography; Pa, aortic pressure; PCI, percutaneous coronary intervention; Pd, distal coronary pressure.

• 

  Fig. 5. Degree of hyperemic DPV increase according to pre-PCI FFR quartiles and pre-PCI STDE-CFC categories in lesions with low and high pre-PCI FFR settings. Vessels are divided into two groups by the median value of pre-PCI FFR (0.69). Pre-PCI STDE-CFC categorization maintained the ability to discriminate lesions, which potentially achieve higher-level hyperemic DPV increase (> 50%) in both groups, while FFR lost discriminating ability in higher FFR vessels. CFC, coronary flow capacity; DPV, diastolic peak velocity; FFR, fractional flow reserve; STDE, stress transthoracic Doppler echocardiography; PCI, percutaneous coronary intervention.

• 

  Fig. 6. Changes in odds ratio for hyperemic DPV increase by spline curve. The spline curve analysis showed a possible hyperemic DPV increase (> 50%) for the vessels of pre-PCI FFR lower than 0.65. DPV, diastolic peak velocity; FFR, fractional flow reserve; PCI, percutaneous coronary intervention.

• 

  Fig. 7. ROC curves for predicting higher-level hyperemic DPV increase following PCI. The ROC curves showing the prediction of hyperemic DPV increase by clinical demographics (model 1, black), model 1 plus pre-PCI FFR (model 2, blue), model 2 plus pre-PCI hyperemic DPV (model 3, green), and model 3 plus pre-PCI ischemic STDE-CFC (model 4, red). CFC, coronary flow capacity, FFR, fractional flow reserve; LAD, left anterior descending artery; STDE, stress transthoracic Doppler echocardiography; PCI, percutaneous coronary intervention; ROC, receiver operating characteristic; DPV, diastolic peak velocity.