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.
N1 - Funding Information:
This study was supported in part by the Theodore F. Hubbard Foundation. Dr. Porter has received equipment support from Philips Healthcare (Andover, MD) and has been a speaker and received educational/grant support from Bracco Diagnostics (Monroe Township, NJ). This study was supported in part by the Theodore F. Hubbard Foundation. Dr. Porter has received equipment support from Philips Healthcare (Andover, MD) and has been a speaker and received educational/grant support from Bracco Diagnostics (Monroe Township, NJ). We thank Megan Hoesing for her assistance in the preparation of this manuscript. This study was supported in part by the Theodore F. Hubbard Foundation. Dr. Porter has received equipment support from Philips Healthcare (Andover, MD) and has been a speaker and received educational/grant support from Bracco Diagnostics (Monroe Township, NJ).
Publisher Copyright:
© 2019 American Society of Echocardiography
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
SN - 0894-7317
VL - 32
SP - 1095
EP - 1101
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 9
ER -