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Published on: April 13, 2015
Principles of interpretation of coronary velocity and pressure tracings
1Intracoronary Imaging Laboratory, Thoraxcenter, Rotterdam, The Netherlands.
Insights
Functional methods, including pressure gradient and flow velocity measurements, are crucial for assessing stenosis severity, even with advanced imaging. These guidewire techniques offer an in-catheterization lab alternative to non-invasive assessments for coronary circulation.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Biomedical engineering
Background:
- Quantitative angiography and intracoronary imaging are insufficient for precise stenosis severity assessment.
- Functional methods are essential for accurate evaluation of coronary artery lesions.
Purpose of the Study:
- To highlight the importance of functional methods over imaging techniques for stenosis assessment.
- To present guidewire-based pressure and flow velocity measurements as a viable alternative in the catheterization laboratory.
Main Methods:
- Utilizing miniaturized sensors with guidewire technology to measure trans-stenotic pressure gradient and post-stenotic flow velocity.
- Applying complex hemodynamic indices based on instantaneous pressure-flow relationships for improved accuracy.
Main Results:
- Guidewire-based functional assessment provides an alternative to conventional non-invasive methods during interventional procedures.
- Simple cut-off criteria are limited by coronary circulation complexity, especially for intermediate lesions.
Conclusions:
- Functional assessment using pressure gradients and flow velocity is indispensable for stenosis severity evaluation.
- Advanced hemodynamic indices enhance the accuracy of functional assessment in complex coronary scenarios.
Abstract:
The development of quantitative angiography and the introduction of new techniques of intracoronary imaging cannot replace the functional methods for the assessment of stenosis severity. The measurement of the trans-stenotic pressure gradient and of the post-stenotic flow velocity using miniaturized sensors with guidewire technology offers an alternative to the conventional non-invasive methods which is applicable in the catheterization laboratory at the time of the interventional procedure. The complexity of the coronary circulation, however, limits the possibility of establishing simple cut-off criteria to identify the presence of a flow-limiting stenosis. For intermediate lesions, or in the presence of variable haemodynamic conditions, the accuracy of the assessment can be improved by the application of more complex indices, proposed and validated in the animal laboratory and based on the instantaneous relationship between pressure or pressure gradient and flow velocity.
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