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Exploring Coronary Circulatory Response to Stenosis and Its Association With Invasive Physiologic Indexes Using
Joo Myung Lee1, Doyeon Hwang1, Jonghanne Park1
1From Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (J.M.L.); Department of Internal Medicine and Cardiovascular Center (D.H., J.P., J.Z., C.H.K., B.-K.K.) and Department of Nuclear Medicine (J.-I.B., M.S., J.C.P., G.J.C.), Seoul National University Hospital, Korea; Department of Cardiology, China-Japan Union Hospital of Jilin University, Changchun, China (Y.T.); and Institute on Aging, Seoul National University, Korea (G.J.C., B.-K.K.).
Insights
This study reveals how coronary circulation responds to worsening stenosis severity using positron emission tomography and invasive pressure data. Invasive physiological indexes show similar patterns related to lesion severity, aiding treatment decisions.
Area of Science:
- Cardiovascular Physiology
- Medical Imaging
- Interventional Cardiology
Background:
- Invasive physiological assessment is standard for coronary stenosis, but coronary circulatory response to varying lesion severity is not fully understood.
- Understanding these responses is crucial for optimizing treatment strategies in coronary artery disease.
Purpose of the Study:
- To demonstrate coronary circulatory changes in response to increasing coronary stenosis severity.
- To correlate anatomic and hemodynamic lesion severity with invasive physiological indexes.
Main Methods:
- 115 patients with left anterior descending artery stenosis underwent 13N-ammonia positron emission tomography and invasive physiological measurement.
- Myocardial blood flow (MBF) from PET and invasive pressures were used to calculate microvascular and stenosis resistance.
Main Results:
- Progressive stenosis increased pressure gradients and stenosis resistance, while decreasing hyperemic MBF and resting microvascular resistance.
- Resting MBF and hyperemic microvascular resistance remained stable.
- Fractional flow reserve and instantaneous wave-free ratio decreased with increasing stenosis severity and resistance, correlating with reduced hyperemic MBF.
Conclusions:
- Coronary circulation changes dynamically with increasing stenosis severity, as shown by PET-derived MBF and invasive pressure data.
- Current invasive physiological indexes (resting and hyperemic) exhibit similar relationships with varying lesion severities.
Background:
Although invasive physiological assessment for coronary stenosis has become a standard practice to guide treatment strategy, coronary circulatory response and changes in invasive physiological indexes, according to different anatomic and hemodynamic lesion severity, have not been fully demonstrated in patients with coronary artery disease.
Methods:
One hundred fifteen patients with left anterior descending artery stenosis who underwent both 13N-ammonia positron emission tomography and invasive physiological measurement were analyzed. Myocardial blood flow (MBF) measured with positron emission tomography and invasively measured coronary pressures were used to calculate microvascular resistance and stenosis resistance.
Results:
With progressive worsening of angiographic stenosis severity, both resting and hyperemic transstenotic pressure gradient and stenosis resistance increased (P<0.001 for all) and hyperemic MBF (P<0.001) and resting microvascular resistance (P=0.012) decreased. Resting MBF (P=0.383) and hyperemic microvascular resistance (P=0.431) were not changed and maintained stable. Both fractional flow reserve and instantaneous wave-free ratio decreased as angiographic stenosis severity, stenosis resistance, and transstenotic pressure gradient increased and hyperemic MBF decreased (all P<0.001). When the presence of myocardial ischemia was defined by both low hyperemic MBF and low coronary flow reserve, the diagnostic accuracy of fractional flow reserve and instantaneous wave-free ratio did not differ, regardless of cutoff values of hyperemic MBF and coronary flow reserve.
Conclusions:
This study demonstrated how the coronary circulation changes in response to increasing coronary stenosis severity using 13N-ammonium positron emission tomography-derived MBF and invasively measured pressure data. Currently used resting and hyperemic pressure-derived invasive physiological indexes have similar patterns of relationships to the different anatomic and hemodynamic lesion severities.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifier: NCT01366404.
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