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Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
Noninvasive transthoracic doppler flow velocity and invasive thermodilution to assess coronary flow reserve
Kazuki Matsuda1, Masahiro Hoshino1, Eisuke Usui1
1Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Insights
Coronary flow velocity reserve (CFRS-TDE) and coronary flow reserve (CFRthermo) show modest correlation pre-PCI but no correlation post-PCI. These measures are not interchangeable, indicating distinct coronary physiologies after intervention.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Background:
- Coronary flow reserve (CFR) is crucial for prognostication and assessing epicardial stenosis and microvascular function.
- The comparative accuracy of stress transthoracic Doppler echocardiography (TDE)-derived CFR (CFRS-TDE) versus thermodilution-derived CFR (CFRthermo) pre- and post-percutaneous coronary intervention (PCI) is not well-established.
Purpose of the Study:
- To evaluate the correlation between CFRS-TDE and CFRthermo before and after elective PCI guided by fractional flow reserve (FFR).
- To determine if CFRS-TDE and CFRthermo are interchangeable in assessing coronary physiology post-PCI.
Main Methods:
- A prospective registry study included 174 patients undergoing FFR-guided elective PCI for left anterior descending artery (LAD) lesions.
- Invasive physiological measurements and pre- and post-PCI stress TDE examinations were performed.
Main Results:
- A modest correlation (r=0.383) was observed between pre-PCI CFRS-TDE and CFRthermo, with CFRS-TDE underestimating CFRthermo.
- Both CFRS-TDE and CFRthermo significantly increased post-PCI (P<0.001).
- No significant correlation was found between changes in CFRS-TDE and CFRthermo post-PCI (r=0.008) or between post-PCI values (r=0.054).
Conclusions:
- Pre-PCI CFRS-TDE and CFRthermo are modestly correlated but not interchangeable.
- Post-PCI, CFRS-TDE and CFRthermo show no correlation, suggesting they reflect different coronary physiologies.
Background:
Coronary flow reserve (CFR) provides prognostication and coronary physiological information, including epicardial coronary stenosis and microvascular function. The relationship between stress transthoracic Doppler echocardiography (TDE)-derived coronary flow velocity reserve (CFRS-TDE) and thermodilution-derived coronary flow reserve (CFRthermo) before and after elective percutaneous coronary intervention (PCI) remains unclear.
Methods:
This single-center prospective registry study evaluated patients who underwent fractional flow reserve (FFR)-guided elective PCI for left anterior descending artery (LAD) lesions with wire-based invasive physiological measurements and pre- and post-PCI stress TDE examinations.
Results:
A total of 174 LAD lesions from 174 patients were included in the final analysis. A modest correlation was detected between the pre-PCI CFRS-TDE and the pre-PCI CFRthermo (r=0.383, P<0.001). The frequently used CFRS-TDE threshold of 2.0 corresponded to a pre-PCI CFRthermo of 2.18. Pre-PCI CFRS-TDE underestimated pre-PCI CFRthermo [1.89 (1.44-2.31) vs. 2.05 (1.38-2.93), P<0.001]. Both CFRS-TDE and CFRthermo increased significantly post-PCI [pre-PCI CFRS-TDE 1.89 vs. post-PCI CFRS-TDE 2.33, P<0.001; pre-PCI CFRthermo 2.05 (1.38-2.93) vs. post-PCI CFRthermo 2.59 (1.63-3.55), P<0.001]. In contrast, there was no significant relationship between changes in CFRS-TDE and changes in CFRthermo after PCI (r=0.008, P=0.915) or between post-PCI CFRS-TDE and post-PCI CFRthermo (r=0.054, P=0.482).
Conclusions:
Pre-PCI CFRS-TDE and CFRthermo are modestly correlated, but post-PCI CFRS-TDE and CFRthermo have no correlation. CFRS-TDE and CFRthermo are not interchangeable, particularly post-PCI, suggesting that the two metrics represent different coronary physiologies after PCI.
