Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: A mechanistic study

Guus A. de Waard, Christopher J. Broyd, Christopher M. Cook, Nina W. van der Hoeven, Ricardo Petraco, Sukhjinder S. Nijjer, Tim P. van de Hoef, Mauro Echavarria-Pinto, Martijn Meuwissen, Sayan Sen, Paul Knaapen, Javier Escaned, Jan J. Piek, Niels van Royen, Justin E. Davies

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective Diastolic-systolic velocity ratio (DSVR) is a resting index to assess stenoses in the left anterior descending artery (LAD). DSVR can be measured by echocardiographic or intracoronary Doppler flow velocity. The objective of this cohort study was to elucidate the fundamental rationale underlying the decreased DSVR in coronary stenoses. Methods In cohort 1, simultaneous measurements of intracoronary Doppler flow velocity and pressure were acquired in the LAD of 228 stable patients. Phasic stenosis resistance, microvascular resistance and total vascular resistance (defined as stenosis and microvascular resistance combined) were studied during physiological resting conditions. Stenoses were classified according to severity by strata of 0.10 fractional flow reserve (FFR) units. Results DSVR was decreased in stenoses with lower FFR. Stenosis resistance was equal in systole and diastole for every FFR stratum. Microvascular resistance was consistently higher during systole than diastole. In lower FFR strata, stenosis resistance as a percentage of the total vascular resistance increases both during systole and diastole. The difference between the stenosis resistance as a percentage of total vascular resistance during systole and diastole increases for lower FFR strata, with an accompanying rise in diastolic-systolic resistance ratio. A significant inverse correlation was observed between DSVR and the diastolic-systolic resistance ratio (r=0.91, p<0.001). In cohort 2 (n=23), DSVR was measured both invasively and non-invasively by transthoracic echocardiography, yielding a good correlation (r=0.82, p<0.001). Conclusions The rationale by which DSVR is decreased distal to coronary stenoses is dependent on a comparatively higher influence of the increased stenosis resistance on total vascular resistance during diastole than systole.
Original languageEnglish
Article numbere000968
JournalOpen Heart
Volume6
Issue number1
DOIs
Publication statusPublished - 2019

Cite this

de Waard, Guus A. ; Broyd, Christopher J. ; Cook, Christopher M. ; van der Hoeven, Nina W. ; Petraco, Ricardo ; Nijjer, Sukhjinder S. ; van de Hoef, Tim P. ; Echavarria-Pinto, Mauro ; Meuwissen, Martijn ; Sen, Sayan ; Knaapen, Paul ; Escaned, Javier ; Piek, Jan J. ; van Royen, Niels ; Davies, Justin E. / Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: A mechanistic study. In: Open Heart. 2019 ; Vol. 6, No. 1.
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title = "Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: A mechanistic study",
abstract = "Objective Diastolic-systolic velocity ratio (DSVR) is a resting index to assess stenoses in the left anterior descending artery (LAD). DSVR can be measured by echocardiographic or intracoronary Doppler flow velocity. The objective of this cohort study was to elucidate the fundamental rationale underlying the decreased DSVR in coronary stenoses. Methods In cohort 1, simultaneous measurements of intracoronary Doppler flow velocity and pressure were acquired in the LAD of 228 stable patients. Phasic stenosis resistance, microvascular resistance and total vascular resistance (defined as stenosis and microvascular resistance combined) were studied during physiological resting conditions. Stenoses were classified according to severity by strata of 0.10 fractional flow reserve (FFR) units. Results DSVR was decreased in stenoses with lower FFR. Stenosis resistance was equal in systole and diastole for every FFR stratum. Microvascular resistance was consistently higher during systole than diastole. In lower FFR strata, stenosis resistance as a percentage of the total vascular resistance increases both during systole and diastole. The difference between the stenosis resistance as a percentage of total vascular resistance during systole and diastole increases for lower FFR strata, with an accompanying rise in diastolic-systolic resistance ratio. A significant inverse correlation was observed between DSVR and the diastolic-systolic resistance ratio (r=0.91, p<0.001). In cohort 2 (n=23), DSVR was measured both invasively and non-invasively by transthoracic echocardiography, yielding a good correlation (r=0.82, p<0.001). Conclusions The rationale by which DSVR is decreased distal to coronary stenoses is dependent on a comparatively higher influence of the increased stenosis resistance on total vascular resistance during diastole than systole.",
author = "{de Waard}, {Guus A.} and Broyd, {Christopher J.} and Cook, {Christopher M.} and {van der Hoeven}, {Nina W.} and Ricardo Petraco and Nijjer, {Sukhjinder S.} and {van de Hoef}, {Tim P.} and Mauro Echavarria-Pinto and Martijn Meuwissen and Sayan Sen and Paul Knaapen and Javier Escaned and Piek, {Jan J.} and {van Royen}, Niels and Davies, {Justin E.}",
year = "2019",
doi = "10.1136/openhrt-2018-000968",
language = "English",
volume = "6",
journal = "Open Heart",
issn = "2053-3624",
publisher = "BMJ Publishing Group",
number = "1",

}

de Waard, GA, Broyd, CJ, Cook, CM, van der Hoeven, NW, Petraco, R, Nijjer, SS, van de Hoef, TP, Echavarria-Pinto, M, Meuwissen, M, Sen, S, Knaapen, P, Escaned, J, Piek, JJ, van Royen, N & Davies, JE 2019, 'Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: A mechanistic study' Open Heart, vol. 6, no. 1, e000968. https://doi.org/10.1136/openhrt-2018-000968

Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: A mechanistic study. / de Waard, Guus A.; Broyd, Christopher J.; Cook, Christopher M.; van der Hoeven, Nina W.; Petraco, Ricardo; Nijjer, Sukhjinder S.; van de Hoef, Tim P.; Echavarria-Pinto, Mauro; Meuwissen, Martijn; Sen, Sayan; Knaapen, Paul; Escaned, Javier; Piek, Jan J.; van Royen, Niels; Davies, Justin E.

In: Open Heart, Vol. 6, No. 1, e000968, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: A mechanistic study

AU - de Waard, Guus A.

AU - Broyd, Christopher J.

AU - Cook, Christopher M.

AU - van der Hoeven, Nina W.

AU - Petraco, Ricardo

AU - Nijjer, Sukhjinder S.

AU - van de Hoef, Tim P.

AU - Echavarria-Pinto, Mauro

AU - Meuwissen, Martijn

AU - Sen, Sayan

AU - Knaapen, Paul

AU - Escaned, Javier

AU - Piek, Jan J.

AU - van Royen, Niels

AU - Davies, Justin E.

PY - 2019

Y1 - 2019

N2 - Objective Diastolic-systolic velocity ratio (DSVR) is a resting index to assess stenoses in the left anterior descending artery (LAD). DSVR can be measured by echocardiographic or intracoronary Doppler flow velocity. The objective of this cohort study was to elucidate the fundamental rationale underlying the decreased DSVR in coronary stenoses. Methods In cohort 1, simultaneous measurements of intracoronary Doppler flow velocity and pressure were acquired in the LAD of 228 stable patients. Phasic stenosis resistance, microvascular resistance and total vascular resistance (defined as stenosis and microvascular resistance combined) were studied during physiological resting conditions. Stenoses were classified according to severity by strata of 0.10 fractional flow reserve (FFR) units. Results DSVR was decreased in stenoses with lower FFR. Stenosis resistance was equal in systole and diastole for every FFR stratum. Microvascular resistance was consistently higher during systole than diastole. In lower FFR strata, stenosis resistance as a percentage of the total vascular resistance increases both during systole and diastole. The difference between the stenosis resistance as a percentage of total vascular resistance during systole and diastole increases for lower FFR strata, with an accompanying rise in diastolic-systolic resistance ratio. A significant inverse correlation was observed between DSVR and the diastolic-systolic resistance ratio (r=0.91, p<0.001). In cohort 2 (n=23), DSVR was measured both invasively and non-invasively by transthoracic echocardiography, yielding a good correlation (r=0.82, p<0.001). Conclusions The rationale by which DSVR is decreased distal to coronary stenoses is dependent on a comparatively higher influence of the increased stenosis resistance on total vascular resistance during diastole than systole.

AB - Objective Diastolic-systolic velocity ratio (DSVR) is a resting index to assess stenoses in the left anterior descending artery (LAD). DSVR can be measured by echocardiographic or intracoronary Doppler flow velocity. The objective of this cohort study was to elucidate the fundamental rationale underlying the decreased DSVR in coronary stenoses. Methods In cohort 1, simultaneous measurements of intracoronary Doppler flow velocity and pressure were acquired in the LAD of 228 stable patients. Phasic stenosis resistance, microvascular resistance and total vascular resistance (defined as stenosis and microvascular resistance combined) were studied during physiological resting conditions. Stenoses were classified according to severity by strata of 0.10 fractional flow reserve (FFR) units. Results DSVR was decreased in stenoses with lower FFR. Stenosis resistance was equal in systole and diastole for every FFR stratum. Microvascular resistance was consistently higher during systole than diastole. In lower FFR strata, stenosis resistance as a percentage of the total vascular resistance increases both during systole and diastole. The difference between the stenosis resistance as a percentage of total vascular resistance during systole and diastole increases for lower FFR strata, with an accompanying rise in diastolic-systolic resistance ratio. A significant inverse correlation was observed between DSVR and the diastolic-systolic resistance ratio (r=0.91, p<0.001). In cohort 2 (n=23), DSVR was measured both invasively and non-invasively by transthoracic echocardiography, yielding a good correlation (r=0.82, p<0.001). Conclusions The rationale by which DSVR is decreased distal to coronary stenoses is dependent on a comparatively higher influence of the increased stenosis resistance on total vascular resistance during diastole than systole.

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U2 - 10.1136/openhrt-2018-000968

DO - 10.1136/openhrt-2018-000968

M3 - Article

VL - 6

JO - Open Heart

JF - Open Heart

SN - 2053-3624

IS - 1

M1 - e000968

ER -