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Kern MJ. Editorial: Is a 5F guide as good as a 6F guide catheter for invasive physiology measurements? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 60:64-65. [PMID: 37996261 DOI: 10.1016/j.carrev.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Morton J Kern
- Long Beach Veterans Administration Medical Center, 5901 East 7th Street, 111C, Long Beach, CA 90822, United States of America.
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Fernandes JF, Gill H, Nio A, Faraci A, Galli V, Marlevi D, Bissell M, Ha H, Rajani R, Mortier P, Myerson SG, Dyverfeldt P, Ebbers T, Nordsletten DA, Lamata P. Non-invasive cardiovascular magnetic resonance assessment of pressure recovery distance after aortic valve stenosis. J Cardiovasc Magn Reson 2023; 25:5. [PMID: 36717885 PMCID: PMC9885657 DOI: 10.1186/s12968-023-00914-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Decisions in the management of aortic stenosis are based on the peak pressure drop, captured by Doppler echocardiography, whereas gold standard catheterization measurements assess the net pressure drop but are limited by associated risks. The relationship between these two measurements, peak and net pressure drop, is dictated by the pressure recovery along the ascending aorta which is mainly caused by turbulence energy dissipation. Currently, pressure recovery is considered to occur within the first 40-50 mm distally from the aortic valve, albeit there is inconsistency across interventionist centers on where/how to position the catheter to capture the net pressure drop. METHODS We developed a non-invasive method to assess the pressure recovery distance based on blood flow momentum via 4D Flow cardiovascular magnetic resonance (CMR). Multi-center acquisitions included physical flow phantoms with different stenotic valve configurations to validate this method, first against reference measurements and then against turbulent energy dissipation (respectively n = 8 and n = 28 acquisitions) and to investigate the relationship between peak and net pressure drops. Finally, we explored the potential errors of cardiac catheterisation pressure recordings as a result of neglecting the pressure recovery distance in a clinical bicuspid aortic valve (BAV) cohort of n = 32 patients. RESULTS In-vitro assessment of pressure recovery distance based on flow momentum achieved an average error of 1.8 ± 8.4 mm when compared to reference pressure sensors in the first phantom workbench. The momentum pressure recovery distance and the turbulent energy dissipation distance showed no statistical difference (mean difference of 2.8 ± 5.4 mm, R2 = 0.93) in the second phantom workbench. A linear correlation was observed between peak and net pressure drops, however, with strong dependences on the valvular morphology. Finally, in the BAV cohort the pressure recovery distance was 78.8 ± 34.3 mm from vena contracta, which is significantly longer than currently accepted in clinical practise (40-50 mm), and 37.5% of patients displayed a pressure recovery distance beyond the end of the ascending aorta. CONCLUSION The non-invasive assessment of the distance to pressure recovery is possible by tracking momentum via 4D Flow CMR. Recovery is not always complete at the ascending aorta, and catheterised recordings will overestimate the net pressure drop in those situations. There is a need to re-evaluate the methods that characterise the haemodynamic burden caused by aortic stenosis as currently clinically accepted pressure recovery distance is an underestimation.
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Affiliation(s)
- Joao Filipe Fernandes
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
| | - Harminder Gill
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Amanda Nio
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alessandro Faraci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | | | - David Marlevi
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Malenka Bissell
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Hojin Ha
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Korea
| | - Ronak Rajani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Saul G Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - Petter Dyverfeldt
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - David A Nordsletten
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Biomedical Engineering and Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Pablo Lamata
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Johnson DT, Svanerud J, Ahn JM, Bezerra HG, Collison D, van 't Veer M, Hennigan B, De Bruyne B, Kirkeeide RL, Gould KL, Johnson NP. Use of a Pressure Wire for Automatically Correcting Artifacts in Phasic Pressure Tracings From a Fluid-Filled Catheter. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 46:98-105. [PMID: 35918253 DOI: 10.1016/j.carrev.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND/PURPOSE Matching phasic pressure tracings between a fluid-filled catheter and high-fidelity pressure wire has received limited attention, although each part contributes half of the information to clinical decisions. We aimed to study the impact of a novel and automated method for improving the phasic calibration of a fluid-filled catheter by accounting for its oscillatory behavior. METHODS/MATERIALS Retrospective analysis of drift check tracings was performed using our algorithm that corrects for mean difference (offset), temporal delays (timing), differential sensitivity of the manifold transducer and pressure wire sensor (gain), and the oscillatory behavior of the fluid-filled catheter described by its resonant frequency and damping factor (how quickly oscillations disappear after a change in pressure). RESULTS Among 2886 cases, correcting for oscillations showed a large improvement in 28 % and a medium improvement in 41 % (decrease in root mean square error >0.5 mmHg to <1 or 1-2 mmHg, respectively). 96 % of oscillators were underdamped with median damping factor 0.27 and frequency 10.6 Hz. Fractional flow reserve or baseline Pd/Pa demonstrated no clinically important bias when ignoring oscillations. However, uncorrected subcycle non-hyperemic pressure ratios (NHPR) displayed both bias and scatter. CONCLUSIONS By automatically accounting for the oscillatory behavior of a fluid-filled catheter system, phasic matching against a high-fidelity pressure wire can be improved compared to standard equalization methods. The majority of tracings contain artifacts, mainly due to underdamped oscillations, and neglecting them leads to biased estimates of equalization parameters. No clinically important bias exists for whole-cycle metrics, in contrast to significant effects on subcycle NHPR.
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Affiliation(s)
- Daniel T Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America
| | | | | | | | | | - Marcel van 't Veer
- Catharina Hospital and Eindhoven University of Technology, Eindhoven, Netherlands
| | - Barry Hennigan
- Mater Private Hospital and University College, Cork, Ireland
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, TX, United States of America.
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Myouchin K, Takayama K, Wada T, Taguchi H, Tanaka T, Kichikawa K. Treatment of Coral Reef Aorta by Endovascular VIABAHN VBX Balloon-Expandable Stent-Graft Placement. Ann Vasc Dis 2021; 14:244-248. [PMID: 34630766 PMCID: PMC8474083 DOI: 10.3400/avd.cr.20-00168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/24/2021] [Indexed: 11/16/2022] Open
Abstract
Coral reef aorta (CRA) has been described as a rare disease characterized by the presence of dense calcifications of the aorta. In this study, we report on two patients with CRA caused by intermittent claudication (IC) who underwent endovascular VIABAHN VBX balloon-expandable stent-graft (VVBX) placement. Both patients underwent successful endovascular VVBX placement via transfemoral artery approach, and hemostasis was achieved via vascular closure device. Their symptoms were observed to disappear completely after treatment, and they were discharged without serious adverse events. No symptoms were noted at 1.5-year and 1-year follow-up.
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Affiliation(s)
- Kaoru Myouchin
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Nara, Japan
| | - Katsutoshi Takayama
- Department of Interventional Neuroradiology/Radiology Kouseikai Takai Hospital, Kashihara, Nara, Japan
| | - Takeshi Wada
- Department of Interventional Neuroradiology/Radiology Kouseikai Takai Hospital, Kashihara, Nara, Japan
| | - Hidehiko Taguchi
- Department of Interventional Neuroradiology/Radiology Kouseikai Takai Hospital, Kashihara, Nara, Japan
| | - Toshihiro Tanaka
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Nara, Japan
| | - Kimihiko Kichikawa
- Department of Radiology and Interventional Radiology Center, Nara Medical University, Kashihara, Nara, Japan
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Johnson DT, Fournier S, Kirkeeide RL, De Bruyne B, Gould KL, Johnson NP. Phasic pressure measurements for coronary and valvular interventions using fluid-filled catheters: Errors, automated correction, and clinical implications. Catheter Cardiovasc Interv 2020; 96:E268-E277. [PMID: 32077561 PMCID: PMC7539962 DOI: 10.1002/ccd.28780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/13/2019] [Accepted: 02/07/2020] [Indexed: 11/17/2022]
Abstract
Objectives We sought to develop an automatic method for correcting common errors in phasic pressure tracings for physiology‐guided interventions on coronary and valvular stenosis. Background Effective coronary and valvular interventions rely on accurate hemodynamic assessment. Phasic (subcycle) indexes remain intrinsic to valvular stenosis and are emerging for coronary stenosis. Errors, corrections, and clinical implications of fluid‐filled catheter phasic pressure assessments have not been assessed in the current era of ubiquitous, high‐fidelity pressure wire sensors. Methods We recruited patients undergoing invasive coronary physiology assessment. Phasic aortic pressure signals were recorded simultaneously using a fluid‐filled guide catheter and 0.014″ pressure wire before and after standard calibration as well as after pullback. We included additional subjects undergoing hemodynamic assessment before and after transcatheter aortic valve implantation. Using the pressure wire as reference standard, we developed an automatic algorithm to match phasic pressures. Results Removing pressure offset and temporal shift produced the largest improvements in root mean square (RMS) error between catheter and pressure wire signals. However, further optimization <1 mmHg RMS error was possible by accounting for differential gain and the oscillatory behavior of the fluid‐filled guide. The impact of correction was larger for subcycle (like systole or diastole) versus whole‐cycle metrics, indicating a key role for valvular stenosis and emerging coronary pressure ratios. Conclusions When calibrating phasic aortic pressure signals using a pressure wire, correction requires these parameters: offset, timing, gain, and oscillations (frequency and damping factor). Automatically eliminating common errors may improve some clinical decisions regarding physiology‐based intervention.
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Affiliation(s)
- Daniel T Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Stephane Fournier
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium.,Department of Cardiology, Lausanne University Center Hospital, Switzerland
| | - Richard L Kirkeeide
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Bernard De Bruyne
- Department of Cardiology, Cardiovascular Center Aalst OLV Hospital, Aalst, Belgium
| | - K Lance Gould
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
| | - Nils P Johnson
- Weatherhead PET Center, Division of Cardiology, Department of Medicine, McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas
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