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Sakai K, Storozhenko T, Mizukami T, Ohashi H, Bouisset F, Tajima A, van Hoe L, Gallinoro E, Botti G, Mahendiran T, Pardaens S, Brouwers S, Fawaz S, Keeble TR, Davies JR, Sonck J, De Bruyne B, Collet C. Impact of vessel volume on thermodilution measurements in patients with coronary microvascular dysfunction. Catheter Cardiovasc Interv 2024. [PMID: 38566527 DOI: 10.1002/ccd.31020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/05/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Two invasive methods are available to estimate microvascular resistance: bolus and continuous thermodilution. Comparative studies have revealed a lack of concordance between measurements of microvascular resistance obtained through these techniques. AIMS This study aimed to examine the influence of vessel volume on bolus thermodilution measurements. METHODS We prospectively included patients with angina with non-obstructive coronary arteries (ANOCA) undergoing bolus and continuous thermodilution assessments. All patients underwent coronary CT angiography to extract vessel volume. Coronary microvascular dysfunction was defined as coronary flow reserve (CFR) < 2.0. Measurements of absolute microvascular resistance (in Woods units) and index of microvascular resistance (IMR) were compared before and after volumetric adjustment. RESULTS Overall, 94 patients with ANOCA were included in this study. The mean age was 64.7 ± 10.8 years, 48% were female, and 19% had diabetes. The prevalence of CMD was 16% based on bolus thermodilution, while continuous thermodilution yielded a prevalence of 27% (Cohen's Kappa 0.44, 95% CI 0.23-0.65). There was no correlation in microvascular resistance between techniques (r = 0.17, 95% CI -0.04 to 0.36, p = 0.104). The adjustment of IMR by vessel volume significantly increased the agreement with absolute microvascular resistance derived from continuous thermodilution (r = 0.48, 95% CI 0.31-0.63, p < 0.001). CONCLUSIONS In patients with ANOCA, invasive methods based on coronary thermodilution yielded conflicting results for the assessment of CMD. Adjusting IMR with vessel volume improved the agreement with continuous thermodilution for the assessment of microvascular resistance. These findings strongly suggest the importance of considering vessel volume when interpreting bolus thermodilution assessment.
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Affiliation(s)
- Koshiro Sakai
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Medicine, Division of Cardiology, Showa University School of Medicine, Tokyo, Japan
| | - Tatyana Storozhenko
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Prevention and Treatment of Emergency Conditions, L.T. Malaya Therapy National Institute NAMSU, Kharkiv, Ukraine
| | - Takuya Mizukami
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Division of Clinical Pharmacology, Department of Pharmacology, Showa University, Tokyo, Japan
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Hirofumi Ohashi
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Frederic Bouisset
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Toulouse University Hospital, Toulouse, France
| | - Atomu Tajima
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | | | - Emanuele Gallinoro
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Giulia Botti
- Interventional Cardiology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Sofie Brouwers
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Samer Fawaz
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - John R Davies
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- MTRC, Anglia Ruskin School of Medicine, Chelmsford, Essex, UK
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
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2
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Lim PO. Is it a Steal or a Squeeze? Hellenic J Cardiol 2024:S1109-9666(24)00062-9. [PMID: 38453015 DOI: 10.1016/j.hjc.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/03/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024] Open
Affiliation(s)
- Pitt O Lim
- Consultant Cardiologist, St George's Hospital , London, UK.
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3
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Gutiérrez-Barrios A, Cañadas-Pruaño D, Alfaro LM, Gheorghe L, Silva E, Noval-Morillas I, Pino CCC, Rueda RZ, Calle-Pérez G, Vázquez-García R, Toro-Cebada R. Coronary Flow Reserve and Myocardial Resistance Reserve Changes After Transcatheter Aortic Valve Implantation in Aortic Stenosis. Am J Cardiol 2024; 214:109-114. [PMID: 38232809 DOI: 10.1016/j.amjcard.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/09/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
Aortic valve stenosis (AS) induces an alteration in hemodynamic conditions that are responsible for coronary microvasculature impairment. Relief of AS by transcatheter aortic valve implantation (TAVI) is expected to improve the coronary artery hemodynamic. We aimed to assess the midterm effects of TAVI in coronary flow reserve (CFR) and myocardial resistance reserve (MRR) by a continuous intracoronary thermodilution technique. At-rest and hyperemic coronary flow was measured by a continuous thermodilution technique in 23 patients with AS and compared with that in 17 matched controls, and repeated 6 ± 3 months after TAVI in 11 of the patients with AS. In patients with AS, absolute coronary flow at rest was significantly greater, and absolute resistance at rest was significantly less, than in controls (p <0.01 for both), causing less CFR and MRR (1.73 ± 0.4 vs 2.85 ± 1.1, p <0.01 and 1.95 ± 0.4 vs 3.22 ± 1.4, p <0.01, respectively). TAVI implantation yielded a significant 35% increase in CFR (p >0.01) and a 39% increase in MRR (p <0.01) driven by absolute coronary flow at rest reduction (p = 0.03). In patients with AS, CFR and MRR determined by continuous thermodilution are significantly impaired. At 6-month follow-up, TAVI improves these indexes and partially relieves the pathophysiologic alterations, leading to a partial restoration of CFR and MRR.
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Affiliation(s)
- Alejandro Gutiérrez-Barrios
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain.
| | - Dolores Cañadas-Pruaño
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | | | - Livia Gheorghe
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | - Etelvino Silva
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | - Inmaculada Noval-Morillas
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | | | - Ricardo Zayas Rueda
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | - Germán Calle-Pérez
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | - Rafael Vázquez-García
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
| | - Rocio Toro-Cebada
- Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz (INiBICA), University of Cadiz, Cadiz, Spain
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4
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Belmonte M, Gallinoro E, Pijls NHJ, Bertolone DT, Keulards DCJ, Viscusi MM, Storozhenko T, Mizukami T, Mahendiran T, Seki R, Fournier S, de Vos A, Adjedj J, Barbato E, Sonck J, Damman P, Keeble T, Fawaz S, Gutiérrez-Barrios A, Paradies V, Bouisset F, Kern MJ, Fearon WF, Collet C, De Bruyne B. Measuring Absolute Coronary Flow and Microvascular Resistance by Thermodilution: JACC Review Topic of the Week. J Am Coll Cardiol 2024; 83:699-709. [PMID: 38325996 DOI: 10.1016/j.jacc.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024]
Abstract
Diagnosing coronary microvascular dysfunction remains challenging, primarily due to the lack of direct measurements of absolute coronary blood flow (Q) and microvascular resistance (Rμ). However, there has been recent progress with the development and validation of continuous intracoronary thermodilution, which offers a simplified and validated approach for clinical use. This technique enables direct quantification of Q and Rμ, leading to precise and accurate evaluation of the coronary microcirculation. To ensure consistent and reliable results, it is crucial to follow a standardized protocol when performing continuous intracoronary thermodilution measurements. This document aims to summarize the principles of thermodilution-derived absolute coronary flow measurements and propose a standardized method for conducting these assessments. The proposed standardization serves as a guide to ensure the best practice of the method, enhancing the clinical assessment of the coronary microcirculation.
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Affiliation(s)
- Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Department, Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands.
| | | | - Danielle C J Keulards
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Michele Mattia Viscusi
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | | | | | - Thabo Mahendiran
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Ruiko Seki
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Annemiek de Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Julien Adjedj
- Department of Cardiology, Institut Arnault Tzanck, Saint-Laurent-du-Var, France
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Peter Damman
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Mid South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom; Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Samer Fawaz
- Essex Cardiothoracic Centre, Mid South Essex NHS Foundation Trust, Basildon, Essex, United Kingdom; Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - Alejandro Gutiérrez-Barrios
- Cardiology Department, Hospital Puerta del Mar, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de Cádiz, Cádiz, Spain
| | - Valeria Paradies
- Department of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Morton J Kern
- Veteran's Administration Long Beach Health Care System, Long Beach, California, USA
| | - William F Fearon
- Department of Medicine, Division of Cardiology, Stanford Medical Center Palo Alto, Palo Alto, California, USA; VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.
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Ciaramella L, Di Serafino L, Mitrano L, De Rosa ML, Carbone C, Rea FS, Monaco S, Scalamogna M, Cirillo P, Esposito G. Invasive Assessment of Coronary Microcirculation: A State-of-the-Art Review. Diagnostics (Basel) 2023; 14:86. [PMID: 38201395 PMCID: PMC10795746 DOI: 10.3390/diagnostics14010086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open
Abstract
A significant proportion of patients presenting with signs and symptoms of myocardial ischemia have no "significant" epicardial disease; thereby, the assessment of coronary microcirculation gained an important role in improving diagnosis and guiding therapy. In fact, coronary microvascular dysfunction (CMD) could be found in a large proportion of these patients, supporting both symptoms and signs of myocardial ischemia. However, CMD represents a diagnostic challenge for two main reasons: (1) the small dimension of the coronary microvasculature prevents direct angiographic visualization, and (2) despite the availability of specific diagnostic tools, they remain invasive and underused in the current clinical practice. For these reasons, CMD remains underdiagnosed, and most of the patients remain with no specific treatment and quality-of-life-limiting symptoms. Of note, recent evidence suggests that a "full physiology" approach for the assessment of the whole coronary vasculature may offer a significant benefit in terms of symptom improvement among patients presenting with ischemia and non-obstructive coronary artery disease. We analyze the pathophysiology of coronary microvascular dysfunction, providing the readers with a guide for the invasive assessment of coronary microcirculation, together with the available evidence supporting its use in clinical practice.
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Affiliation(s)
| | - Luigi Di Serafino
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy; (L.C.); (L.M.); (M.L.D.R.); (C.C.); (F.S.R.); (S.M.); (M.S.); (P.C.); (G.E.)
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6
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De Bruyne B, Pijls NHJ, Gallinoro E, Candreva A, Fournier S, Keulards DCJ, Sonck J, Van't Veer M, Barbato E, Bartunek J, Vanderheyden M, Wyffels E, De Vos A, El Farissi M, Tonino PAL, Muller O, Collet C, Fearon WF. Microvascular Resistance Reserve for Assessment of Coronary Microvascular Function: JACC Technology Corner. J Am Coll Cardiol 2021; 78:1541-1549. [PMID: 34620412 DOI: 10.1016/j.jacc.2021.08.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023]
Abstract
The need for a quantitative and operator-independent assessment of coronary microvascular function is increasingly recognized. We propose the theoretical framework of microvascular resistance reserve (MRR) as an index specific for the microvasculature, independent of autoregulation and myocardial mass, and based on operator-independent measurements of absolute values of coronary flow and pressure. In its general form, MRR equals coronary flow reserve (CFR) divided by fractional flow reserve (FFR) corrected for driving pressures. In 30 arteries, pressure, temperature, and flow velocity measurements were obtained simultaneously at baseline (BL), during infusion of saline at 10 mL/min (rest) and 20 mL/min (hyperemia). A strong correlation was found between continuous thermodilution-derived MRR and Doppler MRR (r = 0.88; 95% confidence interval: 0.72-0.93; P < 0.001). MRR was independent from the epicardial resistance, the lower the FFR value, the greater the difference between MRR and CFR. Therefore, MRR is proposed as a specific, quantitative, and operator-independent metric to quantify coronary microvascular dysfunction.
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Affiliation(s)
- Bernard De Bruyne
- Cardiovascular Center Aalst, Aalst, Belgium; Lausanne University Centre Hospital, Lausanne, Switzerland.
| | - Nico H J Pijls
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy. https://twitter.com/Egallinoro
| | - Alessandro Candreva
- Cardiovascular Center Aalst, Aalst, Belgium. https://twitter.com/alecandreva
| | | | | | - Jeroen Sonck
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. https://twitter.com/jeroen_sonck
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands; Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Emanuele Barbato
- Cardiovascular Center Aalst, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. https://twitter.com/EmanueleBarba13
| | | | | | | | - Annemiek De Vos
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Mohamed El Farissi
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pim A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Olivier Muller
- Lausanne University Centre Hospital, Lausanne, Switzerland
| | - Carlos Collet
- Cardiovascular Center Aalst, Aalst, Belgium. https://twitter.com/ColletCarlos
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine and Stanford Cardiovascular Institute, Stanford, California, USA
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7
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Adjedj J, Picard F, Mogi S, Bize A, Sambin L, Muller O, Varenne O, De Bruyne B, Ghaleh B. Accurate assessment of coronary blood flow by continuous thermodilution technique: Validation in a swine model. Catheter Cardiovasc Interv 2021; 99:836-843. [PMID: 34080778 DOI: 10.1002/ccd.29802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/26/2021] [Accepted: 05/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess the accuracy of coronary thermodilution measurements made with the RayFlow® infusion catheter. BACKGROUND Measurements of absolute coronary blood flow (ABF) and absolute microvascular resistance (Rμ ) by continuous coronary thermodilution can be obtained in humans but their accuracy using a novel dedicated infusion catheter has not yet been validated. We compared ABF values obtained at different infusion rates to coronary blood flow (CBF) values obtained using flow probes, in swine. METHODS Twelve domestic swine were instrumented with coronary flow probes placed around the left anterior descending and circumflex coronary arteries. ABF was assessed with the RayFlow® infusion catheter during continuous saline infusion at fixed rates of 5 (n = 14), 10 (n = 15), 15 (n = 19), and 20 (n = 12) ml/min. RESULTS In the 60 measurements, ABF measured using thermodilution averaged 41 ± 17 ml/min (range from 17 to 90) and CBF values obtained with the coronary flow probes averaged 37 ± 18 ml/min (range from 8 to 87). The corresponding Rμ values were 1532 ± 791 (range from 323 to 5103) and 1903 ± 1162 (range from 287 to 6000) Woods units using thermodilution and coronary flow probe assessments, respectively. ABF and Rμ values measured using thermodilution were significantly correlated with the corresponding measurements obtained using coronary flow probes (R = 0.84 [0.73-0.95] and R = 0.80 [0.69-0.88], respectively). CONCLUSIONS ABF and Rμ assessed by continuous saline infusion through a RayFlow® catheter closely correlate with measurements obtained with the gold standard coronary flow probes in a swine model.
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Affiliation(s)
- Julien Adjedj
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France.,Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France.,Lausanne University Hospital, Department of Cardiology, Lausanne, Switzerland
| | - Fabien Picard
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France
| | - Satoshi Mogi
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France
| | - Alain Bize
- Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France
| | - Lucien Sambin
- Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France
| | - Olivier Muller
- Lausanne University Hospital, Department of Cardiology, Lausanne, Switzerland
| | - Olivier Varenne
- Arnault Tzanck Institute, Department of Cardiology, Saint Laurent du Var, France.,Paris Descartes University, Faculty of Medicine, Paris, France
| | - Bernard De Bruyne
- Lausanne University Hospital, Department of Cardiology, Lausanne, Switzerland.,Cardiology Department, Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
| | - Bijan Ghaleh
- Cardiology Department, Université Paris Est Créteil, INSERM, IMRB, Créteil, France.,Cardiology Department, École Nationale Vétérinaire d'Alfort, IMRB, Maisons-Alfort, France
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8
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Adjedj J, Picard F, Collet C, Bruneval P, Fournier S, Bize A, Sambin L, Berdeaux A, Varenne O, De Bruyne B, Ghaleh B. Intracoronary Saline-Induced Hyperemia During Coronary Thermodilution Measurements of Absolute Coronary Blood Flow: An Animal Mechanistic Study. J Am Heart Assoc 2020; 9:e015793. [PMID: 32689859 PMCID: PMC7792254 DOI: 10.1161/jaha.120.015793] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Absolute hyperemic coronary blood flow and microvascular resistances can be measured by continuous thermodilution with a dedicated infusion catheter. We aimed to determine the mechanisms of this hyperemic response in animal. Methods and Results Twenty open chest pigs were instrumented with flow probes on coronary arteries. The following possible mechanisms of saline‐induced hyperemia were explored compared with maximal hyperemia achieve with adenosine by testing: (1) various infusion rates; (2) various infusion content and temperature; (3) NO production inhibition with L‐arginine methyl ester and endothelial denudation; (4) effects of vibrations generated by rotational atherectomy and of infusion through one end‐hole versus side‐holes. Saline infusion rates of 5, 10 and 15 mL/min did not reach maximal hyperemia as compared with adenosine. Percentage of coronary blood flow expressed in percent of the coronary blood flow after adenosine were 48±17% at baseline, 57±18% at 5 mL/min, 65±17% at 10 mL/min, 82±26% at 15 mL/min and 107±18% at 20 mL/min. Maximal hyperemia was observed during infusion of both saline at body temperature and glucose 5%, after endothelial denudation, l‐arginine methyl ester administration, and after stent implantation. The activation of a Rota burr in the first millimeters of the epicardial artery also induced maximal hyperemia. Maximal hyperemia was achieved by infusion through lateral side‐holes but not through an end‐hole catheter. Conclusions Infusion of saline at 20 mL/min through a catheter with side holes in the first millimeters of the epicardial artery induces maximal hyperemia. The data indicate that this vasodilation is related neither to the composition/temperature of the indicator nor is it endothelial mediated. It is suggested that it could be elicited by epicardial wall vibrations.
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Affiliation(s)
- Julien Adjedj
- Department of Cardiology Institut Arnault Tzanck Saint Laurent du Var France.,Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland.,U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France.,Faculté de Médecine Paris Descartes Université Paris Descartes Paris France
| | - Fabien Picard
- Faculté de Médecine Paris Descartes Université Paris Descartes Paris France.,AP-HP, Hôpital Cochin Paris France
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV Clinic Aalst Belgium
| | - Patrick Bruneval
- UMR 970 Inserm Paris Cardiovascular Research Center Hôpital Européen Georges Pompidou Paris France
| | - Stephane Fournier
- Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland.,Cardiovascular Center Aalst, OLV Clinic Aalst Belgium
| | - Alain Bize
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
| | - Lucien Sambin
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
| | - Alain Berdeaux
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
| | - Olivier Varenne
- Faculté de Médecine Paris Descartes Université Paris Descartes Paris France.,AP-HP, Hôpital Cochin Paris France
| | - Bernard De Bruyne
- Department of Cardiology Lausanne University Center Hospital Lausanne Switzerland.,Cardiovascular Center Aalst, OLV Clinic Aalst Belgium
| | - Bijan Ghaleh
- U955-IMRB Equipe 03 Inserm UPEC Ecole Nationale Vétérinaire d'Alfort Maisons-Alfort France.,Université Paris Est UMR_S955 UPEC Ecole Nationale Vétérinaire d'Alfort Créteil France
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Picard F, Alansari O, Mogi S, Van't Veer M, Varenne O, Adjedj J. In vitro test-retest repeatability of invasive physiological indices to assess coronary flow. Catheter Cardiovasc Interv 2019; 94:677-683. [PMID: 30838771 DOI: 10.1002/ccd.28177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/02/2019] [Accepted: 02/18/2019] [Indexed: 11/11/2022]
Abstract
AIMS Several invasive techniques are available in clinical practice to assess coronary flow. Nevertheless, the test-retest repeatability of these techniques in a controlled setting has not been reported. Therefore, we sought to evaluate fractional flow reserve (FFR), coronary flow reserve (CFR), index of microvascular resistance (IMR), and absolute coronary blood flow (ABF) with absolute microvascular resistance (AMR) test-retest repeatability using a coronary flow simulator. METHODS AND RESULTS Using a coronary flow simulator (FFR WetLab version 2.0; Abbott Vascular, Santa Clara, CA), we created stenoses ranging from 0% to 70%, with 10% increments. Three different flows were established with their hyperemic phases, and two consecutive measurements were obtained, evaluating the following indices: FFR, CFR, IMR, ABF, and AMR, using a pressure/temperature wire and an infusion catheter. One hundred and thirty-eight pairs of measurements were performed. Test-retest reliability was compared in 48 FFR, 18 CFR, 24 IMR, 24 ABF, and 24 AMR. Test-retest repeatability showed excellent reproducibility for FFR, ABF, and AMR; respectively 0.98 (0.97-0.99), 0.92 (0.81-0.97) and 0.91 (0.79-0.96) (P < 0.0001 for all). However, test-retest repeatability was weaker for IMR and poor for CFR; respectively 0.53 (0.16-0.77) (P = 0.006) and 0.27 (-0.26-0.67) (P = 0.30). CONCLUSIONS Using a coronary flow simulator, FFR and ABF with AMR had excellent test-retest reliability. IMR and CFR demonstrated weaker test-retest reliability.
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Affiliation(s)
- Fabien Picard
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Omar Alansari
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France
| | - Satoshi Mogi
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France
| | - Marcel Van't Veer
- Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Olivier Varenne
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
| | - Julien Adjedj
- Department of Cardiology, Hôpital Cochin, AP-HP, Paris, France.,Faculté de Médecine Paris Descartes, Université Paris Descartes, Paris, France
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