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Is atrial pacing needed for determination of coronary flow reserve by parametric imaging?
G Vassalli1, O M Hess, O N Krogmann
1Division of Cardiology, University Hospital, Zurich, Switzerland.
Insights
Atrial pacing is not mandatory for determining coronary flow reserve (CFR) using parametric imaging. Spontaneous heart rate variations during coronary arteriography do not significantly alter CFR measurements, simplifying the procedure.
Area of Science:
- Cardiology
- Medical Imaging
- Physiology
Background:
- Heart rate fluctuations can impact coronary flow measurements.
- Parametric imaging is used to determine coronary flow reserve (CFR).
- The necessity of atrial pacing for accurate CFR determination is questioned.
Purpose of the Study:
- To investigate whether atrial pacing is essential for accurate CFR measurement using parametric imaging.
- To assess the influence of spontaneous heart rate variations on CFR.
- To compare CFR values obtained during sinus rhythm versus atrial pacing.
Main Methods:
- Coronary flow reserve (CFR) was calculated using digital subtraction angiography (parametric imaging) in 10 patients.
- Measurements were taken at rest and during hyperemia (induced by intracoronary papaverine).
- CFR was assessed during both spontaneous sinus rhythm and atrial pacing.
Main Results:
- Spontaneous heart rate variations during coronary arteriography were minimal (4-5 beats/min).
- CFR values showed no significant difference between sinus rhythm (2.61 +/- 1.01) and atrial pacing (2.67 +/- 1.05).
- The mean absolute difference in CFR was 0.31 +/- 0.31 (12 +/- 10%), indicating minimal impact.
Conclusions:
- Spontaneous heart rate variations during coronary arteriography do not significantly affect CFR measurements.
- Atrial pacing is not mandatory for determining CFR with parametric imaging.
- This finding simplifies the procedure for assessing coronary blood flow.
Abstract:
Heart rate changes during determination of coronary flow by parametric imaging may influence the flow measurement. Thus, the question is whether atrial pacing is mandatory for determination of coronary flow reserve (CFR) by this technique. CFR was calculated by digital subtraction angiography (parametric imaging) in 10 patients (8 with coronary artery disease and 2 control subjects) during sinus rhythm and during atrial pacing. Flow measurements were determined in the perfusion region of the left anterior descending and circumflex coronary artery, both at rest and after maximal coronary vasodilation with 10 mg intracoronary papaverine. CFR was defined as coronary flow during hyperemia divided by coronary flow at rest. Spontaneous heart rate was 71 +/- 15 min-1 at baseline, 73 +/- 15 min-1 after papaverine injection and 85 +/- 10 min-1 during atrial pacing. Heart rate variations during coronary arteriography were 4 +/- 3 min-1 at baseline and 5 +/- 4 min-1 after papaverine administration. CFR was 2.61 +/- 1.01 during sinus rhythm and 2.67 +/- 1.05 during atrial pacing. Mean absolute difference in CFR between sinus rhythm and atrial pacing was 0.31 +/- 0.31 (12 +/- 10% of CFR during pacing). Spontaneous heart rate variations during coronary arteriography are not associated with significant changes in CFR. Thus, atrial pacing is not mandatory for the determination of CFR by parametric imaging.