Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios
Background Post–percutaneous coronary intervention (PCI) fractional flow reserve ≥0.90 is an accepted marker of procedural success, and a cutoff of ≥0.95 has recently been proposed for post‐PCI instantaneous wave‐free ratio. However, stability of nonhyperemic pressure ratios (NHPRs) post‐PCI is not...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-05-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.023554 |
| _version_ | 1828105254772670464 |
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| author | Muhammad Aetesam‐ur‐Rahman Tian X. Zhao Kitty Paques Joana Oliveira Bharat Khialani Stephen Kyranis Denise M. Braganza Sarah C. Clarke Martin R. Bennett Nick E. J. West Stephen P. Hoole |
| author_facet | Muhammad Aetesam‐ur‐Rahman Tian X. Zhao Kitty Paques Joana Oliveira Bharat Khialani Stephen Kyranis Denise M. Braganza Sarah C. Clarke Martin R. Bennett Nick E. J. West Stephen P. Hoole |
| author_sort | Muhammad Aetesam‐ur‐Rahman |
| collection | DOAJ |
| description | Background Post–percutaneous coronary intervention (PCI) fractional flow reserve ≥0.90 is an accepted marker of procedural success, and a cutoff of ≥0.95 has recently been proposed for post‐PCI instantaneous wave‐free ratio. However, stability of nonhyperemic pressure ratios (NHPRs) post‐PCI is not well characterized, and transient reactive submaximal hyperemia post‐PCI may affect their precision. We performed this study to assess stability and reproducibility of NHPRs post‐PCI. Methods and Results Fifty‐seven patients (age, 63.77±10.67 years; men, 71%) underwent hemodynamic assessment immediately post‐PCI and then after a recovery period of 10, 20, and 30 minutes and repeated at 3 months. Manual offline analysis was performed to derive resting and hyperemic pressure indexes (Pd/Pa resting pressure gradient, mathematically derived instantaneous wave‐free ratio, resting full cycle ratio, and fractional flow reserve) and microcirculatory resistances (basal microvascular resistance and index of microvascular resistance). Transient submaximal hyperemia occurring post‐PCI was demonstrated by longer thermodilution time at 30 minutes compared with immediately post‐PCI; mean difference of thermodilution time was 0.17 seconds (95% CI, 0.07–0.26 seconds; P=0.04). Basal microcirculatory resistance was also higher at 30 minutes than immediately post‐PCI; mean difference of basal microvascular resistance was 10.89 mm Hg.s (95% CI, 2.25–19.52 mm Hg.s; P=0.04). Despite this, group analysis confirmed no significant differences in the values of resting whole cycle pressure ratios (Pd/Pa and resting full cycle ratio) as well as diastolic pressure ratios (diastolic pressure ratio and mathematically derived instantaneous wave‐free ratio). Whole cardiac cycle NHPRs demonstrated the best overall stability post‐PCI, and 1 in 5 repeated diastolic NHPRs crossed the clinical decision threshold. Conclusions Whole cycle NHPRs demonstrate better reproducibility and clinical precision post‐PCI than diastolic NHPRs, possibly because of less perturbation from predominantly diastolic reactive hyperemia and left ventricular stunning. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03502083; Unique identifier: NCT03502083 and URL: https://clinicaltrials.gov/ct2/show/NCT03076476; Unique identifier: NCT03076476. |
| first_indexed | 2024-04-11T10:00:25Z |
| format | Article |
| id | doaj.art-511ad4b921144eb2af6456dc040dda07 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-11T10:00:25Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-511ad4b921144eb2af6456dc040dda072022-12-22T04:30:26ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802022-05-0111910.1161/JAHA.121.023554Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle RatiosMuhammad Aetesam‐ur‐Rahman0Tian X. Zhao1Kitty Paques2Joana Oliveira3Bharat Khialani4Stephen Kyranis5Denise M. Braganza6Sarah C. Clarke7Martin R. Bennett8Nick E. J. West9Stephen P. Hoole10Department of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDivision of Cardiovascular Medicine University of Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomDepartment of Interventional Cardiology Royal Papworth Hospital Cambridge United KingdomBackground Post–percutaneous coronary intervention (PCI) fractional flow reserve ≥0.90 is an accepted marker of procedural success, and a cutoff of ≥0.95 has recently been proposed for post‐PCI instantaneous wave‐free ratio. However, stability of nonhyperemic pressure ratios (NHPRs) post‐PCI is not well characterized, and transient reactive submaximal hyperemia post‐PCI may affect their precision. We performed this study to assess stability and reproducibility of NHPRs post‐PCI. Methods and Results Fifty‐seven patients (age, 63.77±10.67 years; men, 71%) underwent hemodynamic assessment immediately post‐PCI and then after a recovery period of 10, 20, and 30 minutes and repeated at 3 months. Manual offline analysis was performed to derive resting and hyperemic pressure indexes (Pd/Pa resting pressure gradient, mathematically derived instantaneous wave‐free ratio, resting full cycle ratio, and fractional flow reserve) and microcirculatory resistances (basal microvascular resistance and index of microvascular resistance). Transient submaximal hyperemia occurring post‐PCI was demonstrated by longer thermodilution time at 30 minutes compared with immediately post‐PCI; mean difference of thermodilution time was 0.17 seconds (95% CI, 0.07–0.26 seconds; P=0.04). Basal microcirculatory resistance was also higher at 30 minutes than immediately post‐PCI; mean difference of basal microvascular resistance was 10.89 mm Hg.s (95% CI, 2.25–19.52 mm Hg.s; P=0.04). Despite this, group analysis confirmed no significant differences in the values of resting whole cycle pressure ratios (Pd/Pa and resting full cycle ratio) as well as diastolic pressure ratios (diastolic pressure ratio and mathematically derived instantaneous wave‐free ratio). Whole cardiac cycle NHPRs demonstrated the best overall stability post‐PCI, and 1 in 5 repeated diastolic NHPRs crossed the clinical decision threshold. Conclusions Whole cycle NHPRs demonstrate better reproducibility and clinical precision post‐PCI than diastolic NHPRs, possibly because of less perturbation from predominantly diastolic reactive hyperemia and left ventricular stunning. Registration URL: https://clinicaltrials.gov/ct2/show/NCT03502083; Unique identifier: NCT03502083 and URL: https://clinicaltrials.gov/ct2/show/NCT03076476; Unique identifier: NCT03076476.https://www.ahajournals.org/doi/10.1161/JAHA.121.023554instantaneous wave‐free rationonhyperemic pressure ratiospost–percutaneous coronary intervention coronary physiologypost–percutaneous coronary intervention hyperemiaresting full cycle ratio |
| spellingShingle | Muhammad Aetesam‐ur‐Rahman Tian X. Zhao Kitty Paques Joana Oliveira Bharat Khialani Stephen Kyranis Denise M. Braganza Sarah C. Clarke Martin R. Bennett Nick E. J. West Stephen P. Hoole Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease instantaneous wave‐free ratio nonhyperemic pressure ratios post–percutaneous coronary intervention coronary physiology post–percutaneous coronary intervention hyperemia resting full cycle ratio |
| title | Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios |
| title_full | Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios |
| title_fullStr | Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios |
| title_full_unstemmed | Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios |
| title_short | Coronary Flow Variations Following Percutaneous Coronary Intervention Affect Diastolic Nonhyperemic Pressure Ratios More Than the Whole Cycle Ratios |
| title_sort | coronary flow variations following percutaneous coronary intervention affect diastolic nonhyperemic pressure ratios more than the whole cycle ratios |
| topic | instantaneous wave‐free ratio nonhyperemic pressure ratios post–percutaneous coronary intervention coronary physiology post–percutaneous coronary intervention hyperemia resting full cycle ratio |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.023554 |
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