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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Coronary pressure measurement identifies patients with diffuse coronary artery disease who benefit from coronary
Kohichiro Iwasaki1, Takeshi Matsumoto
1Department of Cardiology, Okayama Kyokuto Hospital, Nakaku, Okayama, Japan. kiwasaki@kyokuto.or.jp
Insights
Coronary pressure measurement identified distinct patterns in diffuse coronary artery disease. Patients with an abrupt pressure drop pattern showed significant symptom improvement after revascularization.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Diffuse coronary artery disease presents challenges in treatment selection.
- Coronary pressure patterns may offer insights into disease severity and treatment response.
Purpose of the Study:
- To analyze pressure drop patterns in diffuse coronary artery disease.
- To correlate pressure patterns with treatment outcomes and guide therapy.
Main Methods:
- Eighty-three patients with diffuse coronary artery disease underwent pullback coronary pressure measurement.
- Pressure patterns were classified as abrupt or gradual.
- Treatment decisions (revascularization vs. medical therapy) were based on pressure patterns and fractional flow reserve.
Main Results:
- 47 patients had abrupt pressure drop patterns, 36 had gradual patterns.
- Abrupt pattern patients undergoing revascularization showed significant symptomatic improvement (CCS grade reduction).
- Gradual pattern patients primarily received medical therapy, with some improvement observed.
Conclusions:
- Coronary pressure measurement effectively differentiates patients with abrupt vs. gradual pressure drop patterns.
- Patients with abrupt pressure drop patterns benefit significantly from coronary revascularization.
Objective:
We analyzed the pressure drop pattern in patients with diffuse coronary artery disease and treated these patients according to their pressure drop pattern.
Methods:
We measured pullback coronary pressure from the distal to the proximal left anterior descending coronary artery in 83 patients with diffuse coronary artery disease. Coronary pressure pattern was divided into two types: the abrupt and gradual pressure drop patterns. Patients with an abrupt pressure drop pattern and fractional flow reserve less than 0.75 underwent coronary revascularization. Patients with gradual pressure drop pattern received medical therapy except five patients, who underwent coronary bypass surgery because of triple vessel disease. We followed these patients for 8-20 (14.3±4.6) months using the grading system of the Canadian Cardiovascular Society (CCS grade).
Results:
Abrupt pressure drop pattern was observed in 47 patients, whereas the remaining 36 patients showed gradual pressure drop pattern. Angiographic findings did not distinguish these pressure drop patterns. All patients with the abrupt pressure drop pattern except one showed symptomatic improvement (the CCS grade decreased from 2.64±0.76 to 1.09±0.35, P<0.01) in response to coronary revascularization. In patients with the gradual pressure drop pattern, 17 of 36 patients showed improvement of symptoms (the CCS grade decreased from 2.31±0.53 to 1.75±0.77, P<0.01).
Conclusion:
Coronary pressure measurement distinguished patients with abrupt pressure drop pattern from those with gradual pressure drop pattern, and the former group of patients benefited from coronary revascularization.
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