Affiliation:
1. Division of Cardiology Department of Medicine Konkuk University Medical CenterSchool of MedicineKonkuk University Seoul Korea
2. Department of Internal Medicine and Cardiovascular Center Chosun University HospitalUniversity of Chosun College of Medicine Gwangju Korea
3. Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa Carver College of Medicine IA
4. Futuristic Animal Resource and Research Center & National Primate Research Center Korea Research Institute of Bioscience and Biotechnology Chungbuk Korea
5. Department of Internal Medicine and Cardiovascular Center Chonnam National University Hospital Gwangju Korea
6. Division of Cardiovascular Medicine Tsuchiura Kyodo General Hospital Ibaraki Japan
7. Division of Cardiology Department of Internal Medicine Heart Vascular Stroke InstituteSamsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
Abstract
Background
In tandem stenoses, nonhyperemic pressure ratio pullback is the preferred method to fractional flow reserve (FFR), based on the assumption of stable resting coronary flow. This study aimed to evaluate temporal changes of coronary circulatory indexes in tandem stenoses before and after angioplasty for proximal stenosis.
Methods and Results
Coronary tandem stenoses were created by porcine restenosis model with 2 bare metal stents in the left anterior descending artery. Four weeks later, changes in distal coronary pressure (Pd), averaged peak velocity, microvascular resistance, transstenotic pressure gradient across distal stenosis, resting Pd/aortic pressure, and FFR were measured before and 1, 5, 10, 15, and 20 minutes after balloon angioplasty for proximal stenosis. After angioplasty, there were significant changes in both resting and hyperemic Pd, averaged peak velocity, microvascular resistance, and transstenotic pressure gradient across distal stenosis (all
P
values <0.01). After initial acute changes, hyperemic averaged peak velocity and microvascular resistance did not show significant difference from the baseline values (
P
=0.712 and 0.972, respectively). Conversely, resting averaged peak velocity remained increased (10.1±0.7 to 17.8±0.7;
P
<0.001) and resting microvascular resistance decreased (6.0±0.1 to 2.2±0.7;
P
<0.001). Transstenotic pressure gradient across distal stenosis was significantly increased in both resting (13.1±7.6 to 25.3±4.2;
P
=0.040) and hyperemic conditions (11.0±3.0 to 27.4±3.3 mm Hg;
P
<0.001). Actual post–percutaneous coronary intervention Pd/aortic pressure and FFR were significantly lower than predicted values (Pd/aortic pressure, 0.68±0.22 versus 0.85±0.14;
P
<0.001; FFR, 0.63±0.08 versus 0.81±0.08;
P
<0.001).
Conclusions
After angioplasty for proximal stenosis, transstenotic pressure gradient across distal stenosis showed similar changes between resting and hyperemic conditions. Both actual post–percutaneous coronary intervention resting Pd/aortic pressure and FFR were significantly lower than predicted values.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
1 articles.
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