Comparison of fractional flow reserve assessment with demand stress myocardial contrast echocardiography in angiographically intermediate coronary stenoses

Juefei Wu, David Barton, Feng Xie, Edward Lewis O'Leary, John Steuter, Gregory Pavlides, Thomas Richard Porter

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background - Real-time myocardial contrast echocardiography (RTMCE) directly measures capillary flow (CBF), which in turn is a major regulator of coronary flow and resistance during demand or hyperemic stress. Although fractional flow reserve (FFR) was developed to assess the physiological relevance of an epicardial stenosis, it assumes maximal microvascular vasodilation and minimal resistance during vasodilator stress. Therefore, we sought to determine the relationship between CBF assessed with RTMCE during stress echocardiography and FFR in intermediate coronary lesions. Methods and Results - Sixty-seven vessels with 50% to 80% diameter stenoses by quantitative coronary angiography in 58 consecutive patients were examined with FFR and RTMCE (mean age, 60±13 years). RTMCE was performed using an incremental dobutamine (n=32) or exercise (n=26) stress protocol, and myocardial perfusion was assessed using a continuous infusion of ultrasound contrast. The presence or absence of inducible perfusion defects and wall motion abnormalities were correlated with FFR. Mean percent diameter stenosis was 60±9%. Eighteen stenoses (27%) had an FFR ≤ 0.8. Although 17 of the 18 stenoses that were FFR+ had abnormal CBF during RTMCE, 28 of the 49 stenoses (57%) that were FFR had abnormal CBF, and 24 (49%) had abnormal wall motion in the corresponding coronary artery territory during stress echocardiography. Conclusions - In a significant percentage of intermediate stenoses with normal FFR values, CBF during demand stress is reduced, resulting in myocardial ischemia.

Original languageEnglish (US)
Article numbere004129
JournalCirculation: Cardiovascular Imaging
Volume9
Issue number8
DOIs
StatePublished - Aug 1 2016

Fingerprint

Coronary Stenosis
Echocardiography
Pathologic Constriction
Stress Echocardiography
Perfusion
Dobutamine
Coronary Angiography
Vasodilator Agents
Vasodilation
Myocardial Ischemia
Coronary Vessels
Exercise

Keywords

  • coronary angiography
  • coronary artery disease
  • dobutamine
  • myocardial ischemia
  • perfusion imaging

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{36b2f70906d64e08a95af0c50ad69221,
title = "Comparison of fractional flow reserve assessment with demand stress myocardial contrast echocardiography in angiographically intermediate coronary stenoses",
abstract = "Background - Real-time myocardial contrast echocardiography (RTMCE) directly measures capillary flow (CBF), which in turn is a major regulator of coronary flow and resistance during demand or hyperemic stress. Although fractional flow reserve (FFR) was developed to assess the physiological relevance of an epicardial stenosis, it assumes maximal microvascular vasodilation and minimal resistance during vasodilator stress. Therefore, we sought to determine the relationship between CBF assessed with RTMCE during stress echocardiography and FFR in intermediate coronary lesions. Methods and Results - Sixty-seven vessels with 50{\%} to 80{\%} diameter stenoses by quantitative coronary angiography in 58 consecutive patients were examined with FFR and RTMCE (mean age, 60±13 years). RTMCE was performed using an incremental dobutamine (n=32) or exercise (n=26) stress protocol, and myocardial perfusion was assessed using a continuous infusion of ultrasound contrast. The presence or absence of inducible perfusion defects and wall motion abnormalities were correlated with FFR. Mean percent diameter stenosis was 60±9{\%}. Eighteen stenoses (27{\%}) had an FFR ≤ 0.8. Although 17 of the 18 stenoses that were FFR+ had abnormal CBF during RTMCE, 28 of the 49 stenoses (57{\%}) that were FFR had abnormal CBF, and 24 (49{\%}) had abnormal wall motion in the corresponding coronary artery territory during stress echocardiography. Conclusions - In a significant percentage of intermediate stenoses with normal FFR values, CBF during demand stress is reduced, resulting in myocardial ischemia.",
keywords = "coronary angiography, coronary artery disease, dobutamine, myocardial ischemia, perfusion imaging",
author = "Juefei Wu and David Barton and Feng Xie and O'Leary, {Edward Lewis} and John Steuter and Gregory Pavlides and Porter, {Thomas Richard}",
year = "2016",
month = "8",
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language = "English (US)",
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journal = "Circulation: Cardiovascular Imaging",
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TY - JOUR

T1 - Comparison of fractional flow reserve assessment with demand stress myocardial contrast echocardiography in angiographically intermediate coronary stenoses

AU - Wu, Juefei

AU - Barton, David

AU - Xie, Feng

AU - O'Leary, Edward Lewis

AU - Steuter, John

AU - Pavlides, Gregory

AU - Porter, Thomas Richard

PY - 2016/8/1

Y1 - 2016/8/1

N2 - Background - Real-time myocardial contrast echocardiography (RTMCE) directly measures capillary flow (CBF), which in turn is a major regulator of coronary flow and resistance during demand or hyperemic stress. Although fractional flow reserve (FFR) was developed to assess the physiological relevance of an epicardial stenosis, it assumes maximal microvascular vasodilation and minimal resistance during vasodilator stress. Therefore, we sought to determine the relationship between CBF assessed with RTMCE during stress echocardiography and FFR in intermediate coronary lesions. Methods and Results - Sixty-seven vessels with 50% to 80% diameter stenoses by quantitative coronary angiography in 58 consecutive patients were examined with FFR and RTMCE (mean age, 60±13 years). RTMCE was performed using an incremental dobutamine (n=32) or exercise (n=26) stress protocol, and myocardial perfusion was assessed using a continuous infusion of ultrasound contrast. The presence or absence of inducible perfusion defects and wall motion abnormalities were correlated with FFR. Mean percent diameter stenosis was 60±9%. Eighteen stenoses (27%) had an FFR ≤ 0.8. Although 17 of the 18 stenoses that were FFR+ had abnormal CBF during RTMCE, 28 of the 49 stenoses (57%) that were FFR had abnormal CBF, and 24 (49%) had abnormal wall motion in the corresponding coronary artery territory during stress echocardiography. Conclusions - In a significant percentage of intermediate stenoses with normal FFR values, CBF during demand stress is reduced, resulting in myocardial ischemia.

AB - Background - Real-time myocardial contrast echocardiography (RTMCE) directly measures capillary flow (CBF), which in turn is a major regulator of coronary flow and resistance during demand or hyperemic stress. Although fractional flow reserve (FFR) was developed to assess the physiological relevance of an epicardial stenosis, it assumes maximal microvascular vasodilation and minimal resistance during vasodilator stress. Therefore, we sought to determine the relationship between CBF assessed with RTMCE during stress echocardiography and FFR in intermediate coronary lesions. Methods and Results - Sixty-seven vessels with 50% to 80% diameter stenoses by quantitative coronary angiography in 58 consecutive patients were examined with FFR and RTMCE (mean age, 60±13 years). RTMCE was performed using an incremental dobutamine (n=32) or exercise (n=26) stress protocol, and myocardial perfusion was assessed using a continuous infusion of ultrasound contrast. The presence or absence of inducible perfusion defects and wall motion abnormalities were correlated with FFR. Mean percent diameter stenosis was 60±9%. Eighteen stenoses (27%) had an FFR ≤ 0.8. Although 17 of the 18 stenoses that were FFR+ had abnormal CBF during RTMCE, 28 of the 49 stenoses (57%) that were FFR had abnormal CBF, and 24 (49%) had abnormal wall motion in the corresponding coronary artery territory during stress echocardiography. Conclusions - In a significant percentage of intermediate stenoses with normal FFR values, CBF during demand stress is reduced, resulting in myocardial ischemia.

KW - coronary angiography

KW - coronary artery disease

KW - dobutamine

KW - myocardial ischemia

KW - perfusion imaging

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