The Relationship of Capillary Blood Flow Assessments with Real Time Myocardial Perfusion Echocardiography to Invasively Derived Microvascular and Epicardial Assessments

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: The basis for abnormal microvascular flow responses to demand stress in coronary artery disease (CAD) is affected by resistance changes at both the epicardial stenosis level and within the downstream capillary network. We hypothesized that abnormal microvascular perfusion (MVP) responses during demand stress in patients with intermediate coronary stenoses occur when fractional flow reserve (FFR) across the epicardial stenosis is normal, because of increased microvascular resistance. Methods: In 49 coronary arteries of 41 patients with intermediate stenoses (40%-80%) who were referred for both coronary angiography and demand stress MVP assessment, invasive coronary hemodynamics were obtained across the stenosis to measure FFR, coronary flow reserve (CFR), and hyperemic microvascular resistance (HMR) during adenosine infusion. MVP in each coronary artery territory (CAT) during demand stress was evaluated by an independent expert reviewer blinded to clinical and angiographic data. Results: Thirty-four of the 49 CATs with intermediate stenoses exhibited abnormal MVP. Although the sensitivity of MVP was high for detecting abnormal FFR (100%), FFR < 0.8 was observed in only 15 of the 34 vessels that exhibited abnormal MVP (positive predictive value 44%). However, HMR was abnormal in 32 of 34 vessels (94%) with abnormal MVP (positive predictive value, 94%). Conclusions: Although abnormal MVP has high sensitivity for detecting abnormal FFR, MVP is frequently abnormal when FFR is normal. In a large percentage of these patients, invasive assessments of microvascular resistance are abnormal.

Original languageEnglish (US)
Pages (from-to)1095-1101
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume32
Issue number9
DOIs
StatePublished - Sep 2019

Fingerprint

Echocardiography
Perfusion
Pathologic Constriction
Coronary Vessels
Coronary Stenosis
Coronary Angiography
Adenosine
Coronary Artery Disease
Hemodynamics

Keywords

  • Contrast echocardiography
  • Flow reserve
  • Microvascular resistance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

@article{c513f3968c414b8c9aabadfbb73172d5,
title = "The Relationship of Capillary Blood Flow Assessments with Real Time Myocardial Perfusion Echocardiography to Invasively Derived Microvascular and Epicardial Assessments",
abstract = "Background: The basis for abnormal microvascular flow responses to demand stress in coronary artery disease (CAD) is affected by resistance changes at both the epicardial stenosis level and within the downstream capillary network. We hypothesized that abnormal microvascular perfusion (MVP) responses during demand stress in patients with intermediate coronary stenoses occur when fractional flow reserve (FFR) across the epicardial stenosis is normal, because of increased microvascular resistance. Methods: In 49 coronary arteries of 41 patients with intermediate stenoses (40{\%}-80{\%}) who were referred for both coronary angiography and demand stress MVP assessment, invasive coronary hemodynamics were obtained across the stenosis to measure FFR, coronary flow reserve (CFR), and hyperemic microvascular resistance (HMR) during adenosine infusion. MVP in each coronary artery territory (CAT) during demand stress was evaluated by an independent expert reviewer blinded to clinical and angiographic data. Results: Thirty-four of the 49 CATs with intermediate stenoses exhibited abnormal MVP. Although the sensitivity of MVP was high for detecting abnormal FFR (100{\%}), FFR < 0.8 was observed in only 15 of the 34 vessels that exhibited abnormal MVP (positive predictive value 44{\%}). However, HMR was abnormal in 32 of 34 vessels (94{\%}) with abnormal MVP (positive predictive value, 94{\%}). Conclusions: Although abnormal MVP has high sensitivity for detecting abnormal FFR, MVP is frequently abnormal when FFR is normal. In a large percentage of these patients, invasive assessments of microvascular resistance are abnormal.",
keywords = "Contrast echocardiography, Flow reserve, Microvascular resistance",
author = "David Barton and Feng Xie and Edward O'Leary and Chatzizisis, {Yiannis S.} and Gregory Pavlides and Porter, {Thomas R.}",
year = "2019",
month = "9",
doi = "10.1016/j.echo.2019.04.424",
language = "English (US)",
volume = "32",
pages = "1095--1101",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "9",

}

TY - JOUR

T1 - The Relationship of Capillary Blood Flow Assessments with Real Time Myocardial Perfusion Echocardiography to Invasively Derived Microvascular and Epicardial Assessments

AU - Barton, David

AU - Xie, Feng

AU - O'Leary, Edward

AU - Chatzizisis, Yiannis S.

AU - Pavlides, Gregory

AU - Porter, Thomas R.

PY - 2019/9

Y1 - 2019/9

N2 - Background: The basis for abnormal microvascular flow responses to demand stress in coronary artery disease (CAD) is affected by resistance changes at both the epicardial stenosis level and within the downstream capillary network. We hypothesized that abnormal microvascular perfusion (MVP) responses during demand stress in patients with intermediate coronary stenoses occur when fractional flow reserve (FFR) across the epicardial stenosis is normal, because of increased microvascular resistance. Methods: In 49 coronary arteries of 41 patients with intermediate stenoses (40%-80%) who were referred for both coronary angiography and demand stress MVP assessment, invasive coronary hemodynamics were obtained across the stenosis to measure FFR, coronary flow reserve (CFR), and hyperemic microvascular resistance (HMR) during adenosine infusion. MVP in each coronary artery territory (CAT) during demand stress was evaluated by an independent expert reviewer blinded to clinical and angiographic data. Results: Thirty-four of the 49 CATs with intermediate stenoses exhibited abnormal MVP. Although the sensitivity of MVP was high for detecting abnormal FFR (100%), FFR < 0.8 was observed in only 15 of the 34 vessels that exhibited abnormal MVP (positive predictive value 44%). However, HMR was abnormal in 32 of 34 vessels (94%) with abnormal MVP (positive predictive value, 94%). Conclusions: Although abnormal MVP has high sensitivity for detecting abnormal FFR, MVP is frequently abnormal when FFR is normal. In a large percentage of these patients, invasive assessments of microvascular resistance are abnormal.

AB - Background: The basis for abnormal microvascular flow responses to demand stress in coronary artery disease (CAD) is affected by resistance changes at both the epicardial stenosis level and within the downstream capillary network. We hypothesized that abnormal microvascular perfusion (MVP) responses during demand stress in patients with intermediate coronary stenoses occur when fractional flow reserve (FFR) across the epicardial stenosis is normal, because of increased microvascular resistance. Methods: In 49 coronary arteries of 41 patients with intermediate stenoses (40%-80%) who were referred for both coronary angiography and demand stress MVP assessment, invasive coronary hemodynamics were obtained across the stenosis to measure FFR, coronary flow reserve (CFR), and hyperemic microvascular resistance (HMR) during adenosine infusion. MVP in each coronary artery territory (CAT) during demand stress was evaluated by an independent expert reviewer blinded to clinical and angiographic data. Results: Thirty-four of the 49 CATs with intermediate stenoses exhibited abnormal MVP. Although the sensitivity of MVP was high for detecting abnormal FFR (100%), FFR < 0.8 was observed in only 15 of the 34 vessels that exhibited abnormal MVP (positive predictive value 44%). However, HMR was abnormal in 32 of 34 vessels (94%) with abnormal MVP (positive predictive value, 94%). Conclusions: Although abnormal MVP has high sensitivity for detecting abnormal FFR, MVP is frequently abnormal when FFR is normal. In a large percentage of these patients, invasive assessments of microvascular resistance are abnormal.

KW - Contrast echocardiography

KW - Flow reserve

KW - Microvascular resistance

UR - http://www.scopus.com/inward/record.url?scp=85068236312&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068236312&partnerID=8YFLogxK

U2 - 10.1016/j.echo.2019.04.424

DO - 10.1016/j.echo.2019.04.424

M3 - Article

C2 - 31279619

AN - SCOPUS:85068236312

VL - 32

SP - 1095

EP - 1101

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 9

ER -