Circulation. 2017;136(19):1798-1808.
Exploring Coronary Circulatory Response to Stenosis and Its Association With Invasive Physiologic Indexes Using Absolute Myocardial Blood Flow and Coronary Pressure.
제1저자 이주명 · 교신저자 구본권
소속 (2)
- From Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine and Cardiovascular Center (D.H., J.P., J.Z., C.H.K., B.-K.K.) and Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), Seoul National University Hospital, Korea; Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China (Y.T.); and Institute on Aging, Seoul National University, Korea (G.J.C., B.-K.K.).
- From Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine and Cardiovascular Center (D.H., J.P., J.Z., C.H.K., B.-K.K.) and Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), Seoul National University Hospital, Korea; Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China (Y.T.); and Institute on Aging, Seoul National University, Korea (G.J.C., B.-K.K.). bkkoo@snu.ac.kr.
Abstract
BACKGROUND Although invasive physiological assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiological indexes, according to different anatomic and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease.
METHODS One hundred fifteen patients with left anterior descending artery stenosis who underwent both 13N-ammonia positron emission tomography and invasive physiological measurement were analyzed. Myocardial blood flow (MBF) measured with positron emission tomography and invasively measured coronary pressures were used to calculate microvascular resistance and stenosis resistance.
RESULTS With progressive worsening of angiographic stenosis severity, both resting and hyperemic transstenotic pressure gradient and stenosis resistance increased (P<0.001 for all) and hyperemic MBF (P<0.001) and resting microvascular resistance (P=0.012) decreased. Resting MBF (P=0.383) and hyperemic microvascular resistance (P=0.431) were not changed and maintained stable. Both fractional flow reserve and instantaneous wave-free ratio decreased as angiographic stenosis severity, stenosis resistance, and transstenotic pressure gradient increased and hyperemic MBF decreased (all P<0.001). When the presence of myocardial ischemia was defined by both low hyperemic MBF and low coronary flow reserve, the diagnostic accuracy of fractional flow reserve and instantaneous wave-free ratio did not differ, regardless of cutoff values of hyperemic MBF and coronary flow reserve.
CONCLUSIONS This study demonstrated how the coronary circulation changes in response to increasing coronary stenosis severity using 13N-ammonium positron emission tomography-derived MBF and invasively measured pressure data. Currently used resting and hyperemic pressure-derived invasive physiological indexes have similar patterns of relationships to the different anatomic and hemodynamic lesion severities.
CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01366404.
© 2017 American Heart Association, Inc.
Keywords
coronary artery diseasefractional flow reserve, myocardialinstantaneous wave free ratiomyocardial ischemiamyocardial perfusion imagingpositron-emission tomography
그 밖의 정보
- 출판 형태
- Comparative Study, Journal Article
- 저널
- Circulation · eISSN 1524-4539
- 전자 출판
- 2017-08-29
- MeSH
- Aged · Blood Flow Velocity · Blood Pressure* · Cardiac Catheterization* · Coronary Angiography · Coronary Circulation* · Coronary Stenosis / diagnosis / diagnostic imaging / physiopathology · Coronary Vessels / diagnostic imaging / physiopathology · Female · Humans · Hyperemia / physiopathology · Male · Microcirculation · Middle Aged · Myocardial Perfusion Imaging / methods · Nitrogen Radioisotopes / administration & dosage · Positron-Emission Tomography* · Predictive Value of Tests · Prognosis · Radiopharmaceuticals / administration & dosage · Registries · Reproducibility of Results · Republic of Korea · Severity of Illness Index · Vascular Resistance
- Substances
- Nitrogen Radioisotopes · Radiopharmaceuticals
- 데이터
- ClinicalTrials.gov: NCT01366404