Intracoronary measurement of pulsus alternans

Area of Science:

• Cardiology
• Cardiovascular Physiology
• Hemodynamics

Background:

• Pulsus alternans is a clinical sign characterized by regular alternation of the pulse's systolic amplitude.
• It is predominantly associated with severe left ventricular systolic dysfunction.

Observation:

• This case report details a patient presenting with biventricular systolic dysfunction.
• The patient exhibited pulsus alternans not only in the aorta but also in the right ventricle and pulmonary artery.

Findings:

• Coronary angiography identified an intermediate stenosis in the proximal left anterior descending (LAD) artery.
• Pulsus alternans was directly measured in the mid-LAD using a guidewire-mounted pressure sensor.
• Fractional flow reserve (FFR) measurements in the LAD were abnormal, indicating significant hemodynamic compromise.

Implications:

• This case expands the understanding of pulsus alternans, demonstrating its occurrence in biventricular dysfunction.
• It underscores the utility of intracoronary pressure measurement for diagnosing pulsus alternans in specific vascular beds.
• The findings suggest that right ventricular pulsus alternans can be a manifestation of significant coronary artery disease impacting left ventricular function.