Coronary pressure and flow relationships in humans: phasic analysis of normal and pathological vessels and the implications for stenosis assessment: a report from the Iberian–Dutch–English (IDEAL) collaborators
Open Access
- 1 May 2015
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 37 (26), 2069-2080
- https://doi.org/10.1093/eurheartj/ehv626
Abstract
Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR ≤ 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, Ptrend < 0.001 in a curvilinear pattern. Resting flow was unaffected by stenosis severity and was consistent across all strata of stenosis ( Ptrend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures ( Ptrend < 0.001 for both). Microvascular resistance declines with stenosis severity under resting conditions ( Ptrend < 0.001), but was unchanged at hyperaemia (2.3 ± 1.1 mmHg/cm/s; Ptrend = 0.19). With progressive stenosis severity, TG rises. However, while hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses.Keywords
Funding Information
- Medical Research Council
- British Heart Foundation
- National Institute for Health Research
- Institute for Cardiovascular Research
This publication has 32 references indexed in Scilit:
- Physiological Basis and Long-Term Clinical Outcome of Discordance Between Fractional Flow Reserve and Coronary Flow Velocity Reserve in Coronary Stenoses of Intermediate SeverityCirculation: Cardiovascular Interventions, 2014
- Impact of anatomical and functional severity of coronary atherosclerotic plaques on the transmural perfusion gradient: a [15O]H2O PET studyEuropean Heart Journal, 2014
- Disturbed Coronary Hemodynamics in Vessels With Intermediate Stenoses Evaluated With Fractional Flow ReserveCirculation, 2013
- Diagnostic Classification of the Instantaneous Wave-Free Ratio Is Equivalent to Fractional Flow Reserve and Is Not Improved With Adenosine AdministrationJournal of the American College of Cardiology, 2013
- Diagnostic Accuracy of Combined Intracoronary Pressure and Flow Velocity Information During Baseline ConditionsCirculation: Cardiovascular Interventions, 2012
- Physiological Assessment of Coronary Artery Disease in the Cardiac Catheterization LaboratoryCell Metabolism, 2006
- Hyperemic Stenosis Resistance Index for Evaluation of Functional Coronary Lesion SeverityCirculation, 2002
- Validation of Collateral Fractional Flow Reserve by Myocardial Perfusion ImagingCirculation, 2002
- Clinical applications of Doppler coronary flow reserve measurementsThe American Journal of Cardiology, 1993
- Hemodynamic principles in the control of coronary blood flowThe American Journal of Cardiology, 1985