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Published on: September 14, 2017
Frame count reserve
Martin G Stoel1, Felix Zijlstra, Cees A Visser
1Hospital of the Free University, Department of Cardiology, Amsterdam, The Netherlands. mg.stoel@vumc.nl
Insights
TIMI frame count reserve (FCR) can estimate coronary flow velocity reserve (CVR). This angiographic method offers a valuable alternative for assessing coronary stenosis significance in the catheterization lab.
Area of Science:
- Cardiology
- Interventional Cardiology
- Diagnostic Imaging
Background:
- Coronary flow velocity reserve (CVR) assesses coronary stenosis but requires interventional cardiologists.
- An alternative angiographic method is needed for routine use in catheterization labs.
Purpose of the Study:
- To investigate the relationship between TIMI frame count reserve (FCR) and CVR.
- To determine if FCR can serve as an angiographic surrogate for CVR.
Main Methods:
- Calculated relative FCR and CVR in 38 patients for LAD and LCx.
- Measured vessel length and calculated frame count flow velocity.
- Compared FCR and CVR, and relative FCR and relative CVR.
Main Results:
- Strong correlation found between FCR and CVR (r=0.62) and relative FCR and relative CVR (r=0.84).
- No significant differences in mean FCR and CVR between LAD and LCx.
- Vessel length and TIMI frame count differed significantly between LAD and LCx, but flow velocity and volume flow estimations did not.
Conclusions:
- Relative frame count reserve (FCR) can effectively estimate relative coronary flow velocity reserve (CVR).
- FCR provides a viable angiographic alternative for assessing coronary stenosis significance.
Background:
The Doppler wire-derived (relative) coronary flow velocity reserve (CVR) that is used to evaluate functional significance of a coronary stenosis is a method performed only by interventional cardiologists. An angiographic method would be useful in the diagnostic catheterization laboratory. For this purpose, we investigated the relation between TIMI frame count reserve (FCR) and CVR.
Methods And Results:
In 38 patients, (relative) FCR of left anterior descending (LAD) and left circumflex coronary artery (LCx) was calculated by using manual, synchronized contrast agent injections and compared with (relative) CVR. In addition, vessel length was measured with an intracoronary guidewire and frame count flow velocity was calculated and compared with average peak velocity. There was a strong correlation between FCR and CVR (r=0.62, P<0.001) and between relative FCR and relative CVR (r=0.84, P<0.001). The LAD was significantly longer than the LCx (mean, 14.3+/-1.6 cm versus 11.4+/-1.8 cm, P<0.001), and, therefore, TIMI frame count of LAD was significantly higher than of LCx (mean basal 32.5+/-15.1 versus 23.6+/-9.1 and hyperemic 12.1+/-6.6 versus 8.7+/-3.2, both P<0.02). However, all flow velocity measurements and estimations of volume flow were not different for LAD compared with LCx. There were also no differences between mean FCR and CVR of LAD or LCx, of both vessels compared with each other and between mean relative FCR and relative CVR.
Conclusions:
The (relative) frame count reserve can be used to estimate (relative) coronary flow velocity reserve.
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