Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure

Nina W van der Hoeven, Guus A de Waard, Alicia Quirós, Alfonso De Hoyos, Christopher Broyd, Sukhjinder S Nijjer, Tim P van de Hoef, Ricardo Petraco, Roel S Driessen, Hernán Mejía-Rentería, Yuetsu Kikuta, Mauro Echavarría Pinto, Peter M van de Ven, Martijn Meuwissen, Paul Knaapen, Jan J Piek, Justin E Davies, Niels van Royen, Javier Escaned

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

AIMS: Assessment of the coronary circulation has largely been based on pressure ratios (epicardial-) and resistance (micro-vessels). Simultaneous assessment of epicardial- (CEPI) and microvascular conductance (CMICRO) provides an intuitive approach using the same units for both compartments and expressing the actual deliverability of blood. The aim of study was to develop a novel integral method to assessing the functional severity of epicardial and microvascular disease.

METHODS AND RESULTS: We performed intracoronary Doppler and pressure in 403 vessels in 261 stable patients. Hyperaemic mid-to-late diastolic pressure and flow velocity (PV) relationships were calculated. The slope of the aortic PV indicates the overall conductance and the slope of the distal PV relationship represents CMICRO. The intercept with the x-axis represents zero-flow pressure (Pzf). CEPI was derived from microvascular- and overall conductance. Median CEPI was higher compared to CMICRO (4.2 [2.1-8.0] versus 1.3 [1.0-1.7] cm/s/mmHg, p<0.001). CMICRO was independent of stenosis severity (1.3 [1.0-1.7] in FFR≤0.80 versus 1.4 [1.0-1.8] in FFR>0.8, p=0.797). ROC curves (using FFR and HSR concordant vessels as standard) demonstrated an excellent ability of CEPI to characterize significant stenoses (AUC 0.93). When CEPI<CMICRO, we demonstrate a decrease in flow velocity and coronary pressure (optimal cutoff value 0.97, AUC 0.90).

CONCLUSIONS: A comprehensive assessment of separate CEPI and CMICRO was feasible. CEPI has a remarkable diagnostic efficiency to detect a clinically relevant stenosis. When CEPI<CMICRO, distal flow and pressure decrease steeply, indicating myocardial ischemia. CMICRO can be used to explore the severity of microvascular disease.

LanguageEnglish
Pagese1593-e1600
JournalEuroIntervention
Volume14
Issue number15
Early online date24 Apr 2018
DOIs
Publication statusPublished - 8 Feb 2019

Cite this

van der Hoeven, Nina W ; de Waard, Guus A ; Quirós, Alicia ; De Hoyos, Alfonso ; Broyd, Christopher ; Nijjer, Sukhjinder S ; van de Hoef, Tim P ; Petraco, Ricardo ; Driessen, Roel S ; Mejía-Rentería, Hernán ; Kikuta, Yuetsu ; Echavarría Pinto, Mauro ; van de Ven, Peter M ; Meuwissen, Martijn ; Knaapen, Paul ; Piek, Jan J ; Davies, Justin E ; van Royen, Niels ; Escaned, Javier. / Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure. In: EuroIntervention. 2019 ; Vol. 14, No. 15. pp. e1593-e1600.
@article{462018241c304888b0ea5fe229ba80dd,
title = "Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure",
abstract = "AIMS: Assessment of the coronary circulation has largely been based on pressure ratios (epicardial-) and resistance (micro-vessels). Simultaneous assessment of epicardial- (CEPI) and microvascular conductance (CMICRO) provides an intuitive approach using the same units for both compartments and expressing the actual deliverability of blood. The aim of study was to develop a novel integral method to assessing the functional severity of epicardial and microvascular disease.METHODS AND RESULTS: We performed intracoronary Doppler and pressure in 403 vessels in 261 stable patients. Hyperaemic mid-to-late diastolic pressure and flow velocity (PV) relationships were calculated. The slope of the aortic PV indicates the overall conductance and the slope of the distal PV relationship represents CMICRO. The intercept with the x-axis represents zero-flow pressure (Pzf). CEPI was derived from microvascular- and overall conductance. Median CEPI was higher compared to CMICRO (4.2 [2.1-8.0] versus 1.3 [1.0-1.7] cm/s/mmHg, p<0.001). CMICRO was independent of stenosis severity (1.3 [1.0-1.7] in FFR≤0.80 versus 1.4 [1.0-1.8] in FFR>0.8, p=0.797). ROC curves (using FFR and HSR concordant vessels as standard) demonstrated an excellent ability of CEPI to characterize significant stenoses (AUC 0.93). When CEPI<CMICRO, we demonstrate a decrease in flow velocity and coronary pressure (optimal cutoff value 0.97, AUC 0.90).CONCLUSIONS: A comprehensive assessment of separate CEPI and CMICRO was feasible. CEPI has a remarkable diagnostic efficiency to detect a clinically relevant stenosis. When CEPI<CMICRO, distal flow and pressure decrease steeply, indicating myocardial ischemia. CMICRO can be used to explore the severity of microvascular disease.",
author = "{van der Hoeven}, {Nina W} and {de Waard}, {Guus A} and Alicia Quir{\'o}s and {De Hoyos}, Alfonso and Christopher Broyd and Nijjer, {Sukhjinder S} and {van de Hoef}, {Tim P} and Ricardo Petraco and Driessen, {Roel S} and Hern{\'a}n Mej{\'i}a-Renter{\'i}a and Yuetsu Kikuta and {Echavarr{\'i}a Pinto}, Mauro and {van de Ven}, {Peter M} and Martijn Meuwissen and Paul Knaapen and Piek, {Jan J} and Davies, {Justin E} and {van Royen}, Niels and Javier Escaned",
year = "2019",
month = "2",
day = "8",
doi = "10.4244/EIJ-D-18-00021",
language = "English",
volume = "14",
pages = "e1593--e1600",
journal = "EuroIntervention",
issn = "1774-024X",
publisher = "EuroPCR",
number = "15",

}

van der Hoeven, NW, de Waard, GA, Quirós, A, De Hoyos, A, Broyd, C, Nijjer, SS, van de Hoef, TP, Petraco, R, Driessen, RS, Mejía-Rentería, H, Kikuta, Y, Echavarría Pinto, M, van de Ven, PM, Meuwissen, M, Knaapen, P, Piek, JJ, Davies, JE, van Royen, N & Escaned, J 2019, 'Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure', EuroIntervention, vol. 14, no. 15, pp. e1593-e1600. https://doi.org/10.4244/EIJ-D-18-00021

Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure. / van der Hoeven, Nina W; de Waard, Guus A; Quirós, Alicia; De Hoyos, Alfonso; Broyd, Christopher; Nijjer, Sukhjinder S; van de Hoef, Tim P; Petraco, Ricardo; Driessen, Roel S; Mejía-Rentería, Hernán; Kikuta, Yuetsu; Echavarría Pinto, Mauro; van de Ven, Peter M; Meuwissen, Martijn; Knaapen, Paul; Piek, Jan J; Davies, Justin E; van Royen, Niels; Escaned, Javier.

In: EuroIntervention, Vol. 14, No. 15, 08.02.2019, p. e1593-e1600.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Comprehensive physiological evaluation of epicardial and microvascular coronary domains using vascular conductance and zero flow pressure

AU - van der Hoeven, Nina W

AU - de Waard, Guus A

AU - Quirós, Alicia

AU - De Hoyos, Alfonso

AU - Broyd, Christopher

AU - Nijjer, Sukhjinder S

AU - van de Hoef, Tim P

AU - Petraco, Ricardo

AU - Driessen, Roel S

AU - Mejía-Rentería, Hernán

AU - Kikuta, Yuetsu

AU - Echavarría Pinto, Mauro

AU - van de Ven, Peter M

AU - Meuwissen, Martijn

AU - Knaapen, Paul

AU - Piek, Jan J

AU - Davies, Justin E

AU - van Royen, Niels

AU - Escaned, Javier

PY - 2019/2/8

Y1 - 2019/2/8

N2 - AIMS: Assessment of the coronary circulation has largely been based on pressure ratios (epicardial-) and resistance (micro-vessels). Simultaneous assessment of epicardial- (CEPI) and microvascular conductance (CMICRO) provides an intuitive approach using the same units for both compartments and expressing the actual deliverability of blood. The aim of study was to develop a novel integral method to assessing the functional severity of epicardial and microvascular disease.METHODS AND RESULTS: We performed intracoronary Doppler and pressure in 403 vessels in 261 stable patients. Hyperaemic mid-to-late diastolic pressure and flow velocity (PV) relationships were calculated. The slope of the aortic PV indicates the overall conductance and the slope of the distal PV relationship represents CMICRO. The intercept with the x-axis represents zero-flow pressure (Pzf). CEPI was derived from microvascular- and overall conductance. Median CEPI was higher compared to CMICRO (4.2 [2.1-8.0] versus 1.3 [1.0-1.7] cm/s/mmHg, p<0.001). CMICRO was independent of stenosis severity (1.3 [1.0-1.7] in FFR≤0.80 versus 1.4 [1.0-1.8] in FFR>0.8, p=0.797). ROC curves (using FFR and HSR concordant vessels as standard) demonstrated an excellent ability of CEPI to characterize significant stenoses (AUC 0.93). When CEPI<CMICRO, we demonstrate a decrease in flow velocity and coronary pressure (optimal cutoff value 0.97, AUC 0.90).CONCLUSIONS: A comprehensive assessment of separate CEPI and CMICRO was feasible. CEPI has a remarkable diagnostic efficiency to detect a clinically relevant stenosis. When CEPI<CMICRO, distal flow and pressure decrease steeply, indicating myocardial ischemia. CMICRO can be used to explore the severity of microvascular disease.

AB - AIMS: Assessment of the coronary circulation has largely been based on pressure ratios (epicardial-) and resistance (micro-vessels). Simultaneous assessment of epicardial- (CEPI) and microvascular conductance (CMICRO) provides an intuitive approach using the same units for both compartments and expressing the actual deliverability of blood. The aim of study was to develop a novel integral method to assessing the functional severity of epicardial and microvascular disease.METHODS AND RESULTS: We performed intracoronary Doppler and pressure in 403 vessels in 261 stable patients. Hyperaemic mid-to-late diastolic pressure and flow velocity (PV) relationships were calculated. The slope of the aortic PV indicates the overall conductance and the slope of the distal PV relationship represents CMICRO. The intercept with the x-axis represents zero-flow pressure (Pzf). CEPI was derived from microvascular- and overall conductance. Median CEPI was higher compared to CMICRO (4.2 [2.1-8.0] versus 1.3 [1.0-1.7] cm/s/mmHg, p<0.001). CMICRO was independent of stenosis severity (1.3 [1.0-1.7] in FFR≤0.80 versus 1.4 [1.0-1.8] in FFR>0.8, p=0.797). ROC curves (using FFR and HSR concordant vessels as standard) demonstrated an excellent ability of CEPI to characterize significant stenoses (AUC 0.93). When CEPI<CMICRO, we demonstrate a decrease in flow velocity and coronary pressure (optimal cutoff value 0.97, AUC 0.90).CONCLUSIONS: A comprehensive assessment of separate CEPI and CMICRO was feasible. CEPI has a remarkable diagnostic efficiency to detect a clinically relevant stenosis. When CEPI<CMICRO, distal flow and pressure decrease steeply, indicating myocardial ischemia. CMICRO can be used to explore the severity of microvascular disease.

U2 - 10.4244/EIJ-D-18-00021

DO - 10.4244/EIJ-D-18-00021

M3 - Article

VL - 14

SP - e1593-e1600

JO - EuroIntervention

T2 - EuroIntervention

JF - EuroIntervention

SN - 1774-024X

IS - 15

ER -