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van de Hoef TP, de Waard GA, Meuwissen M, Voskuil M, Chamuleau SAJ, van Royen N, Piek JJ. Invasive coronary physiology: a Dutch tradition. Neth Heart J 2020; 28:99-107. [PMID: 32780339 PMCID: PMC7419414 DOI: 10.1007/s12471-020-01461-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Invasive coronary physiology has been applied since the early days of percutaneous transluminal coronary angioplasty, and has become a rapidly emerging field of research. Many physiology indices have been developed, tested in clinical studies, and are now applied in daily clinical practice. Recent clinical practice guidelines further support the use of advanced invasive physiology methods to optimise the diagnosis and treatment of patients with acute and chronic coronary syndromes. This article provides a succinct review of the history of invasive coronary physiology, the basic concepts of currently available physiological parameters, and will particularly highlight the Dutch contribution to this field of invasive coronary physiology.
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Affiliation(s)
- T P van de Hoef
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - G A de Waard
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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Murai T, Stegehuis VE, van de Hoef TP, Wijntjens GWM, Hoshino M, Kanaji Y, Sugiyama T, Hamaya R, Nijjer SS, de Waard GA, Echavarria‐Pinto M, Knaapen P, Meuwissen M, Davies JE, van Royen N, Escaned J, Siebes M, Kirkeeide RL, Gould KL, Johnson NP, Piek JJ, Kakuta T. Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL. J Am Heart Assoc 2020; 9:e016130. [PMID: 32660310 PMCID: PMC7660740 DOI: 10.1161/jaha.120.016130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 05/29/2020] [Indexed: 01/09/2023]
Abstract
Background Coronary flow capacity (CFC), which is a categorical assessment based on the combination of hyperemic coronary flow and coronary flow reserve (CFR), has been introduced as a comprehensive assessment of the coronary circulation to overcome the limitations of CFR alone. The aim of this study was to quantify coronary flow changes after percutaneous coronary intervention in relation to the classification of CFC and the current physiological cutoff values of fractional flow reserve, instantaneous wave-free ratio, and CFR. Methods and Results Using the combined data set from DEFINE FLOW (Distal Evaluation of Functional Performance With Intravascular Sensors to Assess the Narrowing Effect -Combined Pressure and Doppler FLOW Velocity Measurements) and IDEAL (Iberian-Dutch-English), a total of 133 vessels that underwent intracoronary Doppler flow measurement before and after percutaneous coronary intervention were analyzed. CFC classified prerevascularization lesions as normal (14), mildly reduced (40), moderately reduced (31), and severely reduced (48). Lesions with larger impairment of CFC showed greater increase in coronary flow and vice versa (median percent increase in coronary flow by revascularization: 4.2%, 25.9%, 50.1%, and 145.5%, respectively; P<0.001). Compared with the conventional cutoff values of fractional flow reserve, instantaneous wave-free ratio, and CFR, an ischemic CFC defined as moderately to severely reduced CFC showed higher diagnostic accuracy with higher specificity to predict a >50% increase in coronary flow after percutaneous coronary intervention. Receiver operating characteristic curve analysis demonstrated that only CFC has a superior predictive efficacy to CFR (P<0.05). Multivariate analysis revealed lesions with ischemic CFC to be the independent predictor of a significant coronary flow increase after percutaneous coronary intervention (odds ratio, 10.7; 95% CI, 4.6-24.8; P<0.001). Conclusions CFC showed significant improvement of identification of lesions that benefit from revascularization compared with CFR with respect to coronary flow increase. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02328820.
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Affiliation(s)
| | | | | | | | - Masahiro Hoshino
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Yoshihisa Kanaji
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Tomoyo Sugiyama
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Rikuta Hamaya
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
| | - Sukhjinder S. Nijjer
- Department of CardiologyHammersmith HospitalImperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Guus A. de Waard
- Department of CardiologyNuclear Medicine & PET ResearchAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | | | - Paul Knaapen
- Department of CardiologyNuclear Medicine & PET ResearchAmsterdam UMCVrije UniversiteitAmsterdamThe Netherlands
| | | | - Justin E. Davies
- Department of CardiologyHammersmith HospitalImperial College Healthcare NHS TrustLondonUnited Kingdom
| | - Niels van Royen
- Department of CardiologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Javier Escaned
- Department of CardiologyHospital Clinico San Carlos IDISSC, and Universidad Complutense de MadridMadridSpain
| | - Maria Siebes
- Department of Biomedical Engineering and PhysicsAmsterdam Cardiovascular SciencesAmsterdam UMCUniversity of AmsterdamThe Netherlands
| | - Richard L. Kirkeeide
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - K. Lance Gould
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Nils P. Johnson
- Division of CardiologyDepartment of MedicineWeatherhead PET Imaging CenterUniversity of Texas Medical School and Memorial Hermann HospitalHoustonTX
| | - Jan J. Piek
- Heart CenterAmsterdam UMCAmsterdamThe Netherlands
| | - Tsunekazu Kakuta
- Department of Cardiovascular MedicineTsuchiura Kyodo General HospitalTsuchiuraIbarakiJapan
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Wijntjens GW, van Lavieren MA, van de Hoef TP, Echavarría-Pinto M, Meuwissen M, Stegehuis VE, Murai T, Escaned J, Piek JJ. Pressure-derived estimations of coronary flow reserve are inferior to flow-derived coronary flow reserve as diagnostic and risk stratification tools. Int J Cardiol 2019; 279:6-11. [DOI: 10.1016/j.ijcard.2018.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 11/29/2022]
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4
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Wijntjens GW, van de Hoef TP, Kraak RP, Beijk MA, Sjauw KD, Vis MM, Madera Cambero MI, Brinckman SL, Plomp J, Baan J, Koch KT, Wykrzykowska JJ, Henriques JP, de Winter RJ, Piek JJ. The IMPACT Study (Influence of Sensor-Equipped Microcatheters on Coronary Hemodynamics and the Accuracy of Physiological Indices of Functional Stenosis Severity). Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.116.004645. [DOI: 10.1161/circinterventions.116.004645] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/09/2016] [Indexed: 11/16/2022]
Abstract
Background—
The Navvus pressure sensor–equipped microcatheter allows to measure functional stenosis severity over a work-horse guidewire and is used as a more feasible alternative to regular sensor-equipped wires. However, Navvus is larger in diameter than contemporary sensor-equipped guidewires and may, thereby, influence functional measurements. The present study evaluates the hemodynamic influence of the Navvus microcatheter.
Methods and Results—
In patients with intermediate coronary stenosis, coronary pressure and flow velocity were measured using a dual sensor–equipped guidewire before and after introduction of Navvus. Patients were randomized to microcatheter-first or guidewire-first measurement. The primary end point was the difference in hyperemic stenosis resistance index between measurements before and after introduction of Navvus. Measurements were completed in 28 patients (28 stenoses). Mean hyperemic stenosis resistance was 0.37±0.19 Hg/cm/s for wire-only assessment and 0.48±0.26 Hg/cm/s after Navvus introduction (
P
<0.001). Bland–Altman analysis documented a mean bias of +0.11 Hg/cm/s (limits of agreement: −0.13 to 0.36), proportional to mean hyperemic stenosis resistance (Spearman ρ =0.61;
P
=0.001). Passing–Bablok analysis revealed absence of a constant difference but significant proportional difference between the methods. Mean fractional flow reserve was 0.86±0.06 for wire-only assessment and 0.82±0.07 after Navvus introduction (
P
<0.001). Bland–Altman analysis documented a mean bias of −0.033 (limits of agreement: −0.09 to 0.03), proportional to mean fractional flow reserve (Spearman ρ =0.40;
P
=0.036). Passing–Bablok analysis revealed significant constant and proportional differences between methods. Similar results were documented for resting indices of stenosis severity.
Conclusions—
Introduction of the Navvus microcatheter leads to clinically relevant stenosis severity overestimation in intermediate stenosis.
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Affiliation(s)
- Gilbert W.M. Wijntjens
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Tim P. van de Hoef
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Robin P. Kraak
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Marcel A. Beijk
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Krischan D. Sjauw
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - M. Marije Vis
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Maribel I. Madera Cambero
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Stijn L. Brinckman
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Jacobus Plomp
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Jan Baan
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Karel T. Koch
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Joanna J. Wykrzykowska
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - José P. Henriques
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Robbert J. de Winter
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
| | - Jan J. Piek
- From the AMC Heart Center, Academic Medical Center, University of Amsterdam, The Netherlands (G.W.M.W., T.P.v.d.H., R.P.K., M.A.B., K.D.S., M.M.V., J.B., K.T.K., J.J.W., J.P.H., R.J.d.W., J.J.P.); and Department of Cardiology, Tergooi Hospital, Blaricum, The Netherlands (T.P.v.d.H., M.I.M.C., S.L.B., J.P.)
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van de Hoef TP, Echavarría-Pinto M, van Lavieren MA, Meuwissen M, Serruys PW, Tijssen JG, Pocock SJ, Escaned J, Piek JJ. Diagnostic and Prognostic Implications of Coronary Flow Capacity. JACC Cardiovasc Interv 2015; 8:1670-80. [DOI: 10.1016/j.jcin.2015.05.032] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 04/27/2015] [Accepted: 05/07/2015] [Indexed: 11/25/2022]
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Pirich C, Keinrath P, Rettenbacher L, Rendl G, Holzmannhofer J, Hammerer M, Schuler J, Beheshti M. 99mTc tetrofosmin myocardial perfusion scintigraphy in CAD. Performance with early and standard delayed acquisition and fractional flow reserve. Nuklearmedizin 2014; 53:111-6. [PMID: 24963973 DOI: 10.3413/nukmed-0617-13-08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 10/02/2013] [Indexed: 11/20/2022]
Abstract
AIM Early stress imaging (15 min after injection of the radiopharmaceutical) in 99mTc tetrofosmin myocardial perfusion scintigraphy (MPS) has been shown feasible in comparison to standard imaging after 45 minutes, but the effects on image quality and diagnostic accuracy ask for further evaluation. PATIENTS, METHODS 97 patients (61 men, 36 women, age 69 ± 11 years) underwent both early (EA) and standard (SA) acquisition (after 14 ± 4 min and 43 ± 6 min, respectively) using 99mTc tetrofosmin gated SPECT with iterative reconstruction. Sub-diaphragmatic tracer activity and image quality was scored in a 4-point scale by blinded observers. Semiquantitative myocardial perfusion analysis was performed on a 17-segment model using standard cardiac quantification SPECT software (4 DM-SPECT). Stenoses of indeterminate haemodynamic significance were validated by measurement of fractional flow reserve (FFR). RESULTS Extra-cardiac tracer activity was more commonly found in EA (43%) than in SA (38%), but without any diagnostic impact in > 95% of the patients. The mean summed stress score was significantly higher for early than standard imaging (6.4 ± 6.3 vs. 5.6 ± 6.1, p = 0.009). The amount of ischaemic area was not significantly different (EA: 9.1 ± 6.7 % vs. SA: 7.8 ± 6.9 %). The mean stress ejection fraction was 52 ± 11% (EA) compared to 55 ± 11 % (SA) (p = ns). FFR was inversely related to SDS at early (r = -0.704, p < 0.05) and standard (r = -0.678, p < 0.05) acquisition. All patients with a FFR < 0.8 (considered as hemodynamically significant stenoses) revealed a positive scan. CONCLUSION Stress 99mTc tetrofosmin MPS with early acquisition is feasible and at least equally accurate when iterative reconstruction is applied.
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Affiliation(s)
- C Pirich
- Prof. Dr. Christian Pirich, Department of Nuclear Medicine and Endocrinology, University Hospital Salzburg,, Muellner Hauptstrasse 48, 5020 Salzburg, Austria, Tel.+43/662/44 82 35 00, Fax +43/662/44 82 35 11, E-mail:
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7
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van de Hoef TP, van Lavieren MA, Damman P, Delewi R, Piek MA, Chamuleau SAJ, Voskuil M, Henriques JPS, Koch KT, de Winter RJ, Spaan JAE, Siebes M, Tijssen JGP, Meuwissen M, Piek JJ. Physiological basis and long-term clinical outcome of discordance between fractional flow reserve and coronary flow velocity reserve in coronary stenoses of intermediate severity. Circ Cardiovasc Interv 2014; 7:301-11. [PMID: 24782198 DOI: 10.1161/circinterventions.113.001049] [Citation(s) in RCA: 276] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Discordance between fractional flow reserve (FFR) and coronary flow velocity reserve (CFVR) may reflect important coronary pathophysiology but usually remains unnoticed in clinical practice. We evaluated the physiological basis and clinical outcome associated with FFR/CFVR discordance. METHODS AND RESULTS We studied 157 intermediate coronary stenoses in 157 patients, evaluated by FFR and CFVR between April 1997 and September 2006 in which revascularization was deferred. Long-term follow-up was performed to document the occurrence of major adverse cardiac events: cardiac death, myocardial infarction, or target vessel revascularization. Discordance between FFR and CFVR occurred in 31% and 37% of stenoses at the 0.75, and 0.80 FFR cut-off value, respectively, and was characterized by microvascular resistances during basal and hyperemic conditions. Follow-up duration amounted to 11.7 years (Q1-Q3, 9.9-13.3 years). Compared with concordant normal results of FFR and CFVR, a normal FFR with an abnormal CFVR was associated with significantly increased major adverse cardiac events rate throughout 10 years of follow-up, regardless of the FFR cut-off applied. In contrast, an abnormal FFR with a normal CFVR was associated with equivalent clinical outcome compared with concordant normal results: ≤ 3 years when FFR <0.75 was depicted abnormal and throughout 10 years of follow-up when FFR ≤ 0.80 was depicted abnormal. CONCLUSIONS Discordance of CFVR with FFR originates from the involvement of the coronary microvasculature. Importantly, the risk for major adverse cardiac events associated with FFR/CFVR discordance is mainly attributable to stenoses where CFVR is abnormal. This emphasizes the requirement of intracoronary flow assessment in addition to coronary pressure for optimal risk stratification in stable coronary artery disease.
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Affiliation(s)
- Tim P van de Hoef
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.).
| | - Martijn A van Lavieren
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Peter Damman
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Ronak Delewi
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Martijn A Piek
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Steven A J Chamuleau
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Michiel Voskuil
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - José P S Henriques
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Karel T Koch
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Robbert J de Winter
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jos A E Spaan
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Maria Siebes
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan G P Tijssen
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Martijn Meuwissen
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
| | - Jan J Piek
- From the AMC Heartcenter Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., P.D., R.D., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., M.M., J.J.P.); Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands (T.P.v.d.H., J.A.E.S., M.S.); Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.J.C., M.V.); and Amphia Hospital, Breda, The Netherlands (M.M.)
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8
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Nolte F, van de Hoef TP, Meuwissen M, Voskuil M, Chamuleau SAJ, Henriques JPS, Verberne HJ, van Eck-Smit BLF, Koch KT, de Winter RJ, Spaan JAE, Tijssen JGP, Siebes M, Piek JJ. Increased hyperaemic coronary microvascular resistance adds to the presence of myocardial ischaemia. EUROINTERVENTION 2014; 9:1423-31. [PMID: 24755383 DOI: 10.4244/eijv9i12a240] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS It has been argued that hyperaemic microvascular resistance (HMR), defined as the ratio of mean distal coronary pressure to flow velocity, is overestimated in the presence of a coronary stenosis compared to actual microvascular resistance (MR), due to neglecting collateral flow. We aimed to test the hypothesis that HMR allows accurate identification of microvascular functional abnormalities by evaluating the association between high or low HMR and the presence of myocardial ischaemia on non-invasive stress testing. METHODS AND RESULTS Myocardial perfusion scintigraphy was performed in 228 patients, with 299 lesions to identify reversible myocardial ischaemia. Intracoronary distal pressure and flow velocity were assessed during adenosine-induced hyperaemia (20-40 µg, intracoronary) to determine hyperaemic stenosis resistance (HSR) and HMR. HMR >1.9 mmHg/cm/s was defined as high. The diagnostic odds ratio (OR) for myocardial ischaemia for lesions associated with high compared to low HMR was 2.6 (95% confidence interval [CI]: 1.5-4.4; p<0.001) overall, 3.3 (95% CI: 1.2-9.0; p=0.02) for lesions with HSR >0.8 mmHg/cm/s, and 1.3 (95% CI: 0.6-2.9; p=0.52) for lesions with HSR ≤0.8 mmHg/cm/s. CONCLUSIONS The increased risk of myocardial ischaemia in the presence of high HMR, uncorrected for collateral flow, demonstrates that HMR is reflective of an increase in actual MR, identifying pertinent pathophysiological alterations in the microvasculature.
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Affiliation(s)
- Froukje Nolte
- Department of Biomedical Engineering and Physics, University of Amsterdam, Amsterdam, The Netherlands
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9
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van de Hoef TP, Nolte F, EchavarrÍa-Pinto M, van Lavieren MA, Damman P, Chamuleau SAJ, Voskuil M, Verberne HJ, Henriques JPS, van Eck-Smit BLF, Koch KT, de Winter RJ, Spaan JAE, Siebes M, Tijssen JGP, Meuwissen M, Piek JJ. Impact of hyperaemic microvascular resistance on fractional flow reserve measurements in patients with stable coronary artery disease: insights from combined stenosis and microvascular resistance assessment. Heart 2014; 100:951-9. [PMID: 24727867 DOI: 10.1136/heartjnl-2013-305124] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Fractional flow reserve (FFR) aims to identify the extent of epicardial disease, but may be obscured by involvement of the coronary microvasculature. We documented the impact of hyperaemic stenosis resistance (HSR) and hyperaemic microvascular resistance (HMR) on FFR, and its relationship with myocardial ischaemia in patients with stable coronary artery disease. METHODS AND RESULTS We evaluated 255 coronary arteries with stenoses of intermediate severity by means of intracoronary pressure and flow measurements to determine FFR, HSR and HMR. Myocardial perfusion scintigraphy (MPS) was performed to identify inducible myocardial ischaemia. In 178 patients, HMR was additionally determined in a reference coronary artery. Target vessel HMR was stratified according to reference vessel HMR tertiles. The diagnostic OR for inducible ischaemia on MPS of a positive compared with a negative FFR was significantly higher only in the presence of a high HMR (at the 0.75 and 0.80 FFR cut-off). Among stenoses with a positive FFR, the prevalence of ischaemia was significantly higher when HMR was high despite equivalent FFR across the HMR groups. This was paralleled by a concomitant significant increase in HSR with increasing HMR across groups. The relation between FFR and HSR (r(2)=0.54, p<0.001) was modulated by the magnitude of HMR, and improved substantially after adjustment for HMR (adjusted-r(2)=0.73, p<0.001), where, for epicardial disease of equivalent severity, FFR increased with increasing HMR. CONCLUSIONS Identification of epicardial disease severity by FFR is partly obscured by the microvascular resistance, which illustrates the necessity of combined pressure and flow measurements in daily practice.
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Affiliation(s)
- Tim P van de Hoef
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Department of Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands Hospital Clínico San Carlos and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Froukje Nolte
- Department of Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Mauro EchavarrÍa-Pinto
- Hospital Clínico San Carlos and Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Martijn A van Lavieren
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Damman
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Michiel Voskuil
- Department of Cardiology, University Medical Centre, Utrecht, The Netherlands
| | - Hein J Verberne
- Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - José P S Henriques
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Berthe L F van Eck-Smit
- Department of Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Karel T Koch
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Robbert J de Winter
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jos A E Spaan
- Department of Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Maria Siebes
- Department of Biomedical Engineering and Physics, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Jan G P Tijssen
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jan J Piek
- AMC Heartcentre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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10
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van de Hoef TP, Bax M, Damman P, Delewi R, Hassell ME, Piek MA, Chamuleau SA, Voskuil M, van Eck-Smit BL, Verberne HJ, Henriques JP, Koch KT, de Winter RJ, Tijssen JG, Piek JJ, Meuwissen M. Impaired Coronary Autoregulation Is Associated With Long-term Fatal Events in Patients With Stable Coronary Artery Disease. Circ Cardiovasc Interv 2013; 6:329-35. [DOI: 10.1161/circinterventions.113.000378] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Tim P. van de Hoef
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Matthijs Bax
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Peter Damman
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Ronak Delewi
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Mariëlla E.C.J. Hassell
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Martijn A. Piek
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Steven A.J. Chamuleau
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Michiel Voskuil
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Berthe L.F. van Eck-Smit
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Hein J. Verberne
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - José P.S. Henriques
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Karel T. Koch
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Robbert J. de Winter
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Jan G.P. Tijssen
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Jan J. Piek
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
| | - Martijn Meuwissen
- From the Departments of Cardiology (T.P.v.d.H., P.D., R.D., M.E.C.J.H., M.A.P., J.P.S.H., K.T.K., R.J.d.W., J.G.P.T., J.J.P., M.M.) and Nuclear Medicine (B.L.F.v.E.-S., H.J.V.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands (M.B.); Department of Cardiology, University Medical Center, Utrecht, The Netherlands (S.A.J.C., M.V.); and Department of Cardiology, Amphia Hospital, Breda, The
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Sahiner I, Akdemir UO, Kocaman SA, Sahinarslan A, Timurkaynak T, Unlu M. Quantitative evaluation improves specificity of myocardial perfusion SPECT in the assessment of functionally significant intermediate coronary artery stenoses: a comparative study with fractional flow reserve measurements. Ann Nucl Med 2012. [DOI: 10.1007/s12149-012-0666-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Long-term prognostic value of CFVR and FFR versus perfusion scintigraphy in patients with multivessel disease. Neth Heart J 2011; 15:369-74. [PMID: 18176638 DOI: 10.1007/bf03086017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE In this multicentre study, we investigated the long-term prognostic value of intracoronary derived haemodynamic parameters compared with the results of myocardial perfusion scintigraphy (MPS). METHODS Patients (n=191) who were referred for angioplasty of a severe lesion in the presence of an intermediate lesion in another coronary artery were included. MPS was performed to determine the presence of reversible perfusion defects in the area of the intermediate lesion. Coronary flow velocity reserve (CFVR), and additionally fractional flow reserve (FFR; n=129), were determined distal to the intermediate lesion; CFVR >/=2.0 and FFR >/=0.75 were considered negative. RESULTS In total 67 events occurred in 49 patients (3 deaths, 9 MI, 9 CABG, 46 PTCA) during a mean of 793 days follow-up. Event-free survival was 63% for MPS, 79% for CFVR, and 79% for FFR if a negative test result was obtained. The relative risk was 1.2 (not significant) for MPS, 2.2 (p=0.001) for CFVR, and 2.4 (p=0.004) for FFR. CONCLUSION Selective evaluation of an intermediate lesion using CFVR or FFR allows more adequate risk stratification in patients with multivessel disease than MPS. A CFVR <2.0 or a FFR <0.75 was associated with a significant increase of the occurrence of cardiac events during long-term follow-up, predominantly associated with revascularisation. (Neth Heart J 2007;15:369-74.).
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van der Wall EE, de Boer MJ, Doevendans PA, Wilde AA, Zijlstra F. Journal metrics for the Netherlands Heart Journal. Neth Heart J 2011; 19:159-161. [PMID: 21475678 PMCID: PMC3058508 DOI: 10.1007/s12471-011-0099-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, the Netherlands
| | - M. J. de Boer
- Department of Cardiology, University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - P. A. Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - A. A. Wilde
- Department of Cardiology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | - F. Zijlstra
- Department of Cardiology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
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14
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Evidence of scar tissue: contra-indication to cardiac resynchronization therapy? Int J Cardiovasc Imaging 2010; 27:59-63. [PMID: 20614190 PMCID: PMC3035785 DOI: 10.1007/s10554-010-9664-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 06/25/2010] [Indexed: 11/06/2022]
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van der Wall EE, Scholte AJ, Bax JJ. Gated myocardial SPECT imaging; true additional value in AMI? Int J Cardiovasc Imaging 2010; 26:893-6. [PMID: 20532632 PMCID: PMC2991157 DOI: 10.1007/s10554-010-9650-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Accepted: 05/27/2010] [Indexed: 12/01/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - A. J. Scholte
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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van der Wall EE, van Velzen JE, de Graaf FR, Boogers MM, Schuijf JD, Bax JJ. Increased accuracy in computed tomography coronary angiography; a new body surface area adapted protocol. Int J Cardiovasc Imaging 2010; 26:601-4. [PMID: 20396952 PMCID: PMC2868173 DOI: 10.1007/s10554-010-9628-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 04/02/2010] [Indexed: 11/25/2022]
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17
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van der Wall EE, Siebelink HM, Bax JJ. Left ventricular mass assessment by CMR; how to define the optimal index. Int J Cardiovasc Imaging 2010; 26:469-72. [PMID: 20213471 PMCID: PMC2852595 DOI: 10.1007/s10554-010-9602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 02/08/2010] [Indexed: 11/26/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - H. M. Siebelink
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, Netherlands
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18
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Cardiac resynchronization therapy; the importance of evaluating cardiac metabolism. Int J Cardiovasc Imaging 2010; 26:293-7. [PMID: 20148366 PMCID: PMC2846327 DOI: 10.1007/s10554-010-9597-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 01/26/2010] [Indexed: 10/25/2022]
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19
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van der Wall EE, Schalij MJ, Bax JJ. Cardiac resynchronization therapy; evaluation by advanced imaging techniques. Int J Cardiovasc Imaging 2009; 26:199-202. [PMID: 20039137 PMCID: PMC2817077 DOI: 10.1007/s10554-009-9560-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 12/14/2009] [Indexed: 11/30/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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20
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Rees M. The relationship between myocardial SPECT and fractional flow reserve: is it drifting apart? Int J Cardiovasc Imaging 2009; 26:215-6. [PMID: 20033785 DOI: 10.1007/s10554-009-9558-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/04/2009] [Indexed: 11/24/2022]
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21
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van der Wall EE, Schuijf JD, Bax JJ, Jukema JW, Schalij MJ. CT perfusion angiography; beware of artifacts! Int J Cardiovasc Imaging 2009; 26:355-8. [PMID: 20033784 PMCID: PMC2846328 DOI: 10.1007/s10554-009-9559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 12/04/2009] [Indexed: 12/21/2022]
Affiliation(s)
- E. E. van der Wall
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. D. Schuijf
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. J. Bax
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - J. W. Jukema
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
| | - M. J. Schalij
- Department of Cardiology, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands
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Meuwissen M, Siebes M, Chamuleau SAJ, Verhoeff BJ, Henriques JPS, Spaan JAE, Piek JJ. Role of fractional and coronary flow reserve in clinical decision making in intermediate coronary lesions. Interv Cardiol 2009. [DOI: 10.2217/ica.09.33] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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