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Jong CB, Lu TS, Lin L, Chen TY, Liao MT, Kuo JC. Effect of prolonged pressure equalization on final drifting during pressure wire studies. Sci Rep 2024; 14:11504. [PMID: 38769360 PMCID: PMC11106059 DOI: 10.1038/s41598-024-62440-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 05/16/2024] [Indexed: 05/22/2024] Open
Abstract
Pressure drifting is a troublesome error in invasive coronary function tests. This study aimed to evaluate the relationship between prolonged and short-time pressure equalizations in pressure drifting. Pressure drifting was defined as the pressure gradient between the mean pressure of the distal wire sensor (Pd) and aortic pressure (Pa) when the wire was withdrawn to the tip of the guiding catheter. Significant drifts 1 and 2 were defined as the absolute values of pressure gradients > 2 and > 3 mmHg, respectively. A logistic regression model was used to evaluate the associations between prolonged pressure equalization and each pressure drifting. The prolonged pressure equalization strategy was associated with a lower incidence of drift 1 than the short-time pressure equalization strategy (6.84% vs. 16.92%, p < 0.05). However, no statistical differences were found in the incidence of drift 2 between the prolonged and short-time pressure equalization strategies (4.27% vs. 7.69%, p = 0.34). In the multivariable regression model, only the prolonged pressure equalization strategy predicted a lower incidence of pressure drift 1. In conclusion, the prolonged pressure equalization strategy was associated with a lower incidence of significant pressure drifting with more stringent thresholds than the short-time pressure equalization strategy.
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Affiliation(s)
- Chien-Boon Jong
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.
- College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Tsui-Shan Lu
- Department of Mathematics, National Taiwan Normal University, Taipei, Taiwan
| | - Lin Lin
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Tsung-Yan Chen
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Min-Tsun Liao
- Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jui-Cheng Kuo
- Department of Radiology, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
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Gill H, Fernandes JF, Nio A, Dockerill C, Shah N, Ahmed N, Raymond J, Wang S, Sotelo J, Urbina J, Uribe S, Rajani R, Rhode K, Lamata P. Aortic Stenosis: Haemodynamic Benchmark and Metric Reliability Study. J Cardiovasc Transl Res 2023; 16:862-873. [PMID: 36745287 PMCID: PMC10480252 DOI: 10.1007/s12265-022-10350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 02/07/2023]
Abstract
Aortic stenosis is a condition which is fatal if left untreated. Novel quantitative imaging techniques which better characterise transvalvular pressure drops are being developed but require refinement and validation. A customisable and cost-effective workbench valve phantom circuit capable of replicating valve mechanics and pathology was created. The reproducibility and relationship of differing haemodynamic metrics were assessed from ground truth pressure data alongside imaging compatibility. The phantom met the requirements to capture ground truth pressure data alongside ultrasound and magnetic resonance image compatibility. The reproducibility was successfully tested. The robustness of three different pressure drop metrics was assessed: whilst the peak and net pressure drops provide a robust assessment of the stenotic burden in our phantom, the peak-to-peak pressure drop is a metric that is confounded by non-valvular factors such as wave reflection. The peak-to-peak pressure drop is a metric that should be reconsidered in clinical practice. The left panel shows manufacture of low cost, functional valves. The central section demonstrates circuit layout, representative MRI and US images alongside gross valve morphologies. The right panel shows the different pressure drop metrics that were assessed for reproducibility.
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Affiliation(s)
- Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK.
- Cardiology Department, Guy's and St, Thomas's Hospital, London, UK.
| | - Joao Filipe Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Amanda Nio
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Cameron Dockerill
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Nili Shah
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Naajia Ahmed
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | | | - Shu Wang
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Julio Sotelo
- School of Biomedical Engineering, Universidad de Valparaíso, Valparaíso, Chile
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
| | - Jesus Urbina
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sergio Uribe
- Biomedical Imaging Center, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Intelligent Healthcare Engineering, iHEALTH, Santiago, Chile
- Department of Radiology, Schools of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Institute for Biological and Medical Engineering, Schools of Engineering, Medicine and Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
- Cardiology Department, Guy's and St, Thomas's Hospital, London, UK
| | - Kawal Rhode
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, Becket House, 1 Lambeth Palace Road, SE1 7EU, London, UK
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Feenstra RGT, Seitz A, Boerhout CKM, de Winter RJ, Ong P, Beijk MAM, Piek JJ, Sechtem U, van de Hoef TP. Reference values for intracoronary Doppler flow velocity-derived hyperaemic microvascular resistance index. Int J Cardiol 2023; 371:16-20. [PMID: 36174827 DOI: 10.1016/j.ijcard.2022.09.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes. OBJECTIVE We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index (HMR) in a cohort of angina with no significant epicardial coronary obstruction (ANOCA) patients with no structural pathophysiological alterations in the coronary circulation. METHODS The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n = 12) or (2) tested positively with only angina at rest (n = 29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis. RESULTS In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8-1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6-2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics. CONCLUSION In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A > 2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.
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Affiliation(s)
- Rutger G T Feenstra
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Coen K M Boerhout
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robbert J de Winter
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Marcel A M Beijk
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jan J Piek
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Tim P van de Hoef
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
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