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Correlations between recruitable coronary collateral flow velocities, distal occlusion pressure, and
1Research Institute of Angiocardiology and Cardiovascular Clinic, Kyushu University, Faculty of Medicine, Fukuoka, Japan.
Insights
Doppler guidewire assessment of coronary collateral flow velocity in patients undergoing angioplasty revealed significant correlations with hemodynamic indexes. This technique offers a semiquantitative method for evaluating functional coronary collaterals.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Hemodynamics
Background:
- Direct assessment of human coronary collateral flow remains challenging.
- Coronary collateral circulation plays a crucial role in myocardial protection during ischemia.
Purpose of the Study:
- To correlate Doppler guidewire measurements of coronary collateral flow velocity with hemodynamic and functional parameters.
- To evaluate the utility of Doppler guidewire in assessing recruitable coronary collateral function during angioplasty.
Main Methods:
- Doppler guidewire was used to measure collateral flow velocity in the distal segment of the dilated coronary artery in 26 patients undergoing angioplasty.
- Measurements included flow velocity, distal occlusion pressure, and ST-segment elevation on electrocardiogram.
Main Results:
- Collateral flow signals were detected in 69% of patients during balloon inflation.
- A significant positive correlation was found between collateral flow velocity magnitude and distal occlusion pressure.
- Patients without ST elevation during balloon inflation exhibited higher collateral flow velocity and a greater systolic component.
Conclusions:
- Doppler guidewire assessment provides a semiquantitative evaluation of human coronary collateral functional capacity.
- Higher flow velocity signals and systolic flow predominance indicate functionally significant coronary collaterals.
Abstract:
Direct assessment of coronary collateral flow has been difficult in humans. The goal of this study was to correlate the magnitudes and waveform characteristics of recruitable coronary collateral flow velocity measured with Doppler guidewire with other hemodynamic and functional indexes of collateral circulation in patients during angioplasty. Twenty-six patients [age 60 +/- 10 (SD) years] were studied for measurements of flow velocity at the distal segment of the dilated vessel. Collateral flow signals were demonstrated in 18 patients (69%) during balloon inflation. There was a weak yet significant positive correlation between the magnitude of collateral flow velocity and distal occlusion pressure (p < 0.01). The sum of ischemic ST elevation on the 12-lead electrocardiogram was inversely correlated with distal occlusion pressure, but not with the magnitude of collateral flow velocity. Subgroup analysis between patients with (n = 18) and without (n = 8) ST elevation during balloon inflation revealed higher collateral flow velocity signals (p < 0.0001) and greater systolic components of collateral flow in the latter group (p < 0.0001). Thus, functionally significant coronary collaterals showed greater velocity signals and systolic predominance in flow pattern. The functional capacity of human coronary collaterals may be semiquantitated using the Doppler guidewire technique.