1
|
Ryan M, De Silva K, Morgan H, O’Gallagher K, Demir OM, Rahman H, Ellis H, Dancy L, Sado D, Strange J, Melikian N, Marber M, Shah AM, Chiribiri A, Perera D. Coronary Wave Intensity Analysis as an Invasive and Vessel-Specific Index of Myocardial Viability. Circ Cardiovasc Interv 2022; 15:e012394. [PMID: 36538582 PMCID: PMC9760472 DOI: 10.1161/circinterventions.122.012394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/28/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary angiography and viability testing are the cornerstones of diagnosing and managing ischemic cardiomyopathy. At present, no single test serves both needs. Coronary wave intensity analysis interrogates both contractility and microvascular physiology of the subtended myocardium and therefore has the potential to fulfil the goal of completely assessing coronary physiology and myocardial viability in a single procedure. We hypothesized that coronary wave intensity analysis measured during coronary angiography would predict viability with a similar accuracy to late-gadolinium-enhanced cardiac magnetic resonance imaging. METHODS Patients with a left ventricular ejection fraction ≤40% and extensive coronary disease were enrolled. Coronary wave intensity analysis was assessed during cardiac catheterization at rest, during adenosine-induced hyperemia, and during low-dose dobutamine stress using a dual pressure-Doppler sensing coronary guidewire. Scar burden was assessed with cardiac magnetic resonance imaging. Regional left ventricular function was assessed at baseline and 6-month follow-up after optimization of medical-therapy±revascularization, using transthoracic echocardiography. The primary outcome was myocardial viability, determined by the retrospective observation of functional recovery. RESULTS Forty participants underwent baseline physiology, cardiac magnetic resonance imaging, and echocardiography, and 30 had echocardiography at 6 months; 21/42 territories were viable on follow-up echocardiography. Resting backward compression wave energy was significantly greater in viable than in nonviable territories (-5240±3772 versus -1873±1605 W m-2 s-1, P<0.001), and had comparable accuracy to cardiac magnetic resonance imaging for predicting viability (area under the curve 0.812 versus 0.757, P=0.649); a threshold of -2500 W m-2 s-1 had 86% sensitivity and 76% specificity. CONCLUSIONS Backward compression wave energy has accuracy similar to that of late-gadolinium-enhanced cardiac magnetic resonance imaging in the prediction of viability. Coronary wave intensity analysis has the potential to streamline the management of ischemic cardiomyopathy, in a manner analogous to the effect of fractional flow reserve on the management of stable angina.
Collapse
Affiliation(s)
- Matthew Ryan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kalpa De Silva
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Holly Morgan
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Kevin O’Gallagher
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ozan M. Demir
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Haseeb Rahman
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Howard Ellis
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Luke Dancy
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | - Daniel Sado
- Cardiology Department, King’s College Hospital, London, UK (L.D., D.S., N.M.)
| | | | | | - Michael Marber
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Ajay M. Shah
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| | - Amedeo Chiribiri
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
- Imaging Sciences Division, King’s College London, UK (A.C.)
| | - Divaka Perera
- Cardiovascular Division, King’s College London, UK (M.R., K.D.S., H.M., K.O., O.M.D., H.R., H.E., M.M., A.M.S., D.P.)
| |
Collapse
|
2
|
Eftekhari A, Westra J, Stegehuis V, Holm NR, van de Hoef TP, Kirkeeide RL, Piek JJ, Lance Gould K, Johnson NP, Christiansen EH. Prognostic value of microvascular resistance and its association to fractional flow reserve: a DEFINE-FLOW substudy. Open Heart 2022; 9:openhrt-2022-001981. [PMID: 35410913 PMCID: PMC9003618 DOI: 10.1136/openhrt-2022-001981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective This study aimed to evaluate the prognostic value of hyperemic microvascular resistance (HMR) and its relationship with hyperemic stenosis resistance (HSR) index and fractional flow reserve (FFR) in stable coronary artery disease. Methods This is a substudy of the DEFINE-FLOW cohort (NCT02328820), which evaluated the prognosis of lesions (n=456) after combined FFR and coronary flow reserve (CFR) assessment in a prospective, non-blinded, non-randomised, multicentre study in 12 centres in Europe and Japan. Participants (n=430) were evaluated by wire-based measurement of coronary pressure, flow and vascular resistance (ComboWire XT, Phillips Volcano, San Diego, California, USA). Results Mean FFR and CFR were 0.82±0.10 and 2.2±0.6, respectively. When divided according to FFR and CFR thresholds (above and below 0.80 and 2.0, respectively), HMR was highest in lesions with FFR>0.80 and CFR<2.0 (n=99) compared with lesions with FFR≤0.80 and CFR≥2.0 (n=68) (2.92±1.2 vs 1.91±0.64 mm Hg/cm/s, p<0.001). The FFR value was proportional to the ratio between HMR and the HMR+HSR (total resistance), 95% limits of agreement (−0.032; 0.019), bias (−0.003±0.02) and correlation (r2=0.98, p<0.0001). Cox regression model using HMR as continuous parameter for target vessel failure showed an HR of 1.51, 95% CI (0.9 to 2.4), p=0.10. Conclusions Increased HMR was not associated with a higher rate of adverse clinical events, in this population of mainly stable patients. FFR can be equally well expressed as HMR/HMR+HSR, thereby providing an alternative conceptual formulation linking epicardial severity with microvascular resistance. Trial registration number NCT02328820.
Collapse
Affiliation(s)
- Ashkan Eftekhari
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
- Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Valérie Stegehuis
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark
| | - Tim P van de Hoef
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Jan J Piek
- Amsterdam UMC, University of Amsterdam, Heart Center,Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | | |
Collapse
|
3
|
Marchese N, Barbato E, Di Gioia G, Stanislao M, Valle G, Copetti M, Pellegrini G, Vigna C. Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction. Catheter Cardiovasc Interv 2022; 99:271-279. [DOI: 10.1002/ccd.30065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/07/2021] [Accepted: 12/25/2021] [Indexed: 11/12/2022]
Affiliation(s)
- Nicola Marchese
- Unit of Cardiology Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy
| | - Emanuele Barbato
- Cardiovascular Research Center OLV Hospital Aalst Belgium
- Department of Advanced Biomedical Sciences University Federico II Naples Italy
| | - Giuseppe Di Gioia
- Department of Advanced Biomedical Sciences University Federico II Naples Italy
| | - Mario Stanislao
- Unit of Nuclear Medicine Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy
| | - Guido Valle
- Unit of Nuclear Medicine Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy
| | - Massimiliano Copetti
- Unit of Biostatistics Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy
| | - Giorgia Pellegrini
- Unit of Statistical Sciences Alma Mater Studiorum University of Bologna Bologna Italy
| | - Carlo Vigna
- Unit of Cardiology Fondazione IRCCS Casa Sollievo della Sofferenza San Giovanni Rotondo Foggia Italy
| |
Collapse
|
4
|
Di Gioia G, De Bruyne B, Pellicano M, Bartunek J, Colaiori I, Fiordelisi A, Canciello G, Xaplanteris P, Fournier S, Katbeh A, Franco D, Kodeboina M, Morisco C, Van Praet F, Casselman F, Degrieck I, Stockman B, Vanderheyden M, Barbato E. Fractional flow reserve in patients with reduced ejection fraction. Eur Heart J 2021; 41:1665-1672. [PMID: 31419282 DOI: 10.1093/eurheartj/ehz571] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/15/2019] [Accepted: 07/29/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Fractional flow reserve (FFR) has never been investigated in patients with reduced ejection fraction and associated coronary artery disease (CAD). We evaluated the impact of FFR on the management strategies of these patients and related outcomes. METHODS AND RESULTS From 2002 to 2010, all consecutive patients with left ventricular ejection fraction (LVEF) ≤50% undergoing coronary angiography with ≥1 intermediate coronary stenosis [diameter stenosis (DS)% 50-70%] treated based on angiography (Angiography-guided group) or according to FFR (FFR-guided group) were screened for inclusion. In the FFR-guided group, 433 patients were matched with 866 contemporary patients of the Angiography-guided group. For outcome comparison, 617 control patients with LVEF >50% were included. After FFR, stenotic vessels per patient were significantly downgraded compared with the Angiography-guided group (1.43 ± 0.98 vs. 1.97 ± 0.84; P < 0.001). This was associated with lower revascularization rate (52% vs. 62%; P < 0.001) in the FFR-guided vs. the Angiography-guided group. All-cause death at 5 years of follow-up was significantly lower in the FFR-guided as compared with Angiography-guided group [22% vs. 31%. HR (95% CI) 0.64 (0.51-0.81); P < 0.001]. Similarly, rate of major adverse cardiovascular and cerebrovascular events (MACCE: composite of all-cause death, myocardial infarction, revascularization, and stroke) was significantly lower in the FFR-guided group [40% vs. 46% in the Angiography-guided group. HR (95% CI) 0.81 (0.67-0.97); P = 0.019]. Higher rates of death and MACCE were observed in patients with reduced LVEF compared with the control cohort. CONCLUSIONS In patients with reduced LVEF and CAD, FFR-guided revascularization was associated with lower rates of death and MACCE at 5 years as compared with the Angiography-guided strategy. This beneficial impact was observed in parallel with less coronary artery bypass grafting and more patients deferred to percutaneous coronary intervention or medical therapy.
Collapse
Affiliation(s)
- Giuseppe Di Gioia
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Mariano Pellicano
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Iginio Colaiori
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Antonella Fiordelisi
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Grazia Canciello
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | | | - Stephane Fournier
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Asim Katbeh
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Danilo Franco
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Carmine Morisco
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| | - Frank Van Praet
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Filip Casselman
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Bernard Stockman
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV Clinic, Moorselbaan, 164, B-9300 Aalst, Belgium.,Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Via S. Pansini, 5, 80131, Naples, Italy
| |
Collapse
|
5
|
Diagnostic and Prognostic Value of Gated SPECT MIBI Early Post-Stress Imaging in Patients With Intermediate Duke Treadmill Score. Clin Nucl Med 2013; 38:784-9. [DOI: 10.1097/rlu.0b013e31829f8e5a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
6
|
Current world literature. Curr Opin Cardiol 2011; 26:457-61. [PMID: 21832895 DOI: 10.1097/hco.0b013e32834b1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|