Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL
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 stud...
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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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.120.016130 |
| _version_ | 1818775977316057088 |
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| author | Tadashi Murai Valérie E. Stegehuis Tim P. van de Hoef Gilbert W. M. Wijntjens Masahiro Hoshino Yoshihisa Kanaji Tomoyo Sugiyama Rikuta Hamaya Sukhjinder S. Nijjer Guus A. de Waard Mauro Echavarria‐Pinto Paul Knaapen Martijn Meuwissen Justin E. Davies Niels van Royen Javier Escaned Maria Siebes Richard L. Kirkeeide K. Lance Gould Nils P. Johnson Jan J. Piek Tsunekazu Kakuta |
| author_facet | Tadashi Murai Valérie E. Stegehuis Tim P. van de Hoef Gilbert W. M. Wijntjens Masahiro Hoshino Yoshihisa Kanaji Tomoyo Sugiyama Rikuta Hamaya Sukhjinder S. Nijjer Guus A. de Waard Mauro Echavarria‐Pinto Paul Knaapen Martijn Meuwissen Justin E. Davies Niels van Royen Javier Escaned Maria Siebes Richard L. Kirkeeide K. Lance Gould Nils P. Johnson Jan J. Piek Tsunekazu Kakuta |
| author_sort | Tadashi Murai |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-18T11:05:36Z |
| format | Article |
| id | doaj.art-f8d638014d1041f8b45308545a4742b8 |
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| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T11:05:36Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-f8d638014d1041f8b45308545a4742b82022-12-21T21:10:07ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802020-07-0191410.1161/JAHA.120.016130Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEALTadashi Murai0Valérie E. Stegehuis1Tim P. van de Hoef2Gilbert W. M. Wijntjens3Masahiro Hoshino4Yoshihisa Kanaji5Tomoyo Sugiyama6Rikuta Hamaya7Sukhjinder S. Nijjer8Guus A. de Waard9Mauro Echavarria‐Pinto10Paul Knaapen11Martijn Meuwissen12Justin E. Davies13Niels van Royen14Javier Escaned15Maria Siebes16Richard L. Kirkeeide17K. Lance Gould18Nils P. Johnson19Jan J. Piek20Tsunekazu Kakuta21Heart Center Amsterdam UMC Amsterdam The NetherlandsHeart Center Amsterdam UMC Amsterdam The NetherlandsHeart Center Amsterdam UMC Amsterdam The NetherlandsHeart Center Amsterdam UMC Amsterdam The NetherlandsDepartment of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki JapanDepartment of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki JapanDepartment of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki JapanDepartment of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki JapanDepartment of Cardiology Hammersmith Hospital Imperial College Healthcare NHS Trust London United KingdomDepartment of Cardiology Nuclear Medicine & PET Research Amsterdam UMCVrije Universiteit Amsterdam The NetherlandsDepartment of Cardiology Hospital General ISSSTE Querétaro MéxicoDepartment of Cardiology Nuclear Medicine & PET Research Amsterdam UMCVrije Universiteit Amsterdam The NetherlandsDepartment of Cardiology Amphia Hospital Breda The NetherlandsDepartment of Cardiology Hammersmith Hospital Imperial College Healthcare NHS Trust London United KingdomDepartment of Cardiology Radboud University Medical Center Nijmegen The NetherlandsDepartment of Cardiology Hospital Clinico San Carlos IDISSC, and Universidad Complutense de Madrid Madrid SpainDepartment of Biomedical Engineering and Physics Amsterdam Cardiovascular Sciences Amsterdam UMC University of Amsterdam The NetherlandsDivision of Cardiology Department of Medicine Weatherhead PET Imaging Center University of Texas Medical School and Memorial Hermann Hospital Houston TXDivision of Cardiology Department of Medicine Weatherhead PET Imaging Center University of Texas Medical School and Memorial Hermann Hospital Houston TXDivision of Cardiology Department of Medicine Weatherhead PET Imaging Center University of Texas Medical School and Memorial Hermann Hospital Houston TXHeart Center Amsterdam UMC Amsterdam The NetherlandsDepartment of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Tsuchiura Ibaraki JapanBackground 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.https://www.ahajournals.org/doi/10.1161/JAHA.120.016130coronary blood flowcoronary flow capacitycoronary flow reservefractional flow reservepercutaneous coronary intervention |
| spellingShingle | Tadashi Murai Valérie E. Stegehuis Tim P. van de Hoef Gilbert W. M. Wijntjens Masahiro Hoshino Yoshihisa Kanaji Tomoyo Sugiyama Rikuta Hamaya Sukhjinder S. Nijjer Guus A. de Waard Mauro Echavarria‐Pinto Paul Knaapen Martijn Meuwissen Justin E. Davies Niels van Royen Javier Escaned Maria Siebes Richard L. Kirkeeide K. Lance Gould Nils P. Johnson Jan J. Piek Tsunekazu Kakuta Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary blood flow coronary flow capacity coronary flow reserve fractional flow reserve percutaneous coronary intervention |
| title | Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL |
| title_full | Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL |
| title_fullStr | Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL |
| title_full_unstemmed | Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL |
| title_short | Coronary Flow Capacity to Identify Stenosis Associated With Coronary Flow Improvement After Revascularization: A Combined Analysis From DEFINE FLOW and IDEAL |
| title_sort | coronary flow capacity to identify stenosis associated with coronary flow improvement after revascularization a combined analysis from define flow and ideal |
| topic | coronary blood flow coronary flow capacity coronary flow reserve fractional flow reserve percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.016130 |
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