Premium
Hemodynamic and intravascular ultrasound assessment of myocardial bridging: Fractional flow reserve paradox with dobutamine versus adenosine
Author(s) -
Hakeem Abdul,
Cilingiroglu Mehmet,
Leesar Massoud A.
Publication year - 2009
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.22237
Subject(s) - fractional flow reserve , medicine , dobutamine , hemodynamics , cardiology , intravascular ultrasound , adenosine , angiography , radiology , coronary angiography , myocardial infarction
Compared to coronary angiography, both intravascular ultrasound (IVUS) and CT‐angiography provide important information with respect to the morphological aspects of myocardial bridging (MB). However, these modalities are limited in defining the hemodynamic and clinical significance of MB. Intracoronary Doppler studies demonstrate a peculiar abnormal Doppler flow profile associated with MB. Fractional flow reserve (FFR) after adenosine infusion has been used to assess the hemodynamic significance of MB, but FFR after adenosine induced hyperemia underestimates the significance of MB. On the other hand, high‐dose dobutamine by increasing the contractility of the bridging segment unmasks ischemia induced by MB. This review outlines the role of flow velocity measurement by intracoronary Doppler, FFR, and IVUS for assessment of patients with MB. In addition, we compared FFR measurements after adenosine versus dobutamine infusions for the hemodynamic assessment of MB in two patients. © 2009 Wiley‐Liss, Inc.