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Pressure‐wire based assessment of microvascular resistance using calibrated upstream balloon obstruction
Author(s) -
Kim JuneHong,
Park JuHyun,
Choo Kiseok,
Song SungKook,
Kim JungSu,
Park YoungHyun,
Kim Jun,
Chun KookJin,
Han Dongcheul,
Faranesh Anthony Z.,
Lederman Robert J.
Publication year - 2011
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.23277
Subject(s) - medicine , cardiology , aortic pressure , myocardial infarction , balloon , percutaneous coronary intervention , stent , culprit , fractional flow reserve , blood pressure , coronary angiography
Objectives : We assess microvascular integrity as a marker of myocardial viability after coronary stenting, using only a pressure guidewire. Background : Microvascular integrity generally is not assessed using pressure‐only guidewires because the transducer lies upstream of microvasculature. We partially inflate a balloon inside a coronary stent to achieve a specific normalized pressure drop at rest (distal coronary/aortic pressure = 0.8) and then infuse a vasodilator, to render the wire sensitive to microvascular function. We hypothesize that the further decline in pressure (ΔFFR 0.8 ) predicts MRI myocardial viability. Methods : We studied 29 subjects with acute coronary syndrome including myocardial infarction. After successful culprit stenting, the resting coronary/aortic pressure was set to 0.8 using temporary balloon obstruction. ΔFFR 0.8 was defined as 0.8‐(distal coronary/aortic pressures) during adenosine‐induced hyperemia. The average transmural extent of infarction was defined as the average area of MRI late gadolinium enhancement (after 2.8 ± 1.5 days) divided by the corresponding full thickness of the gadolinium enhanced sector in short axis slices, and was compared with ΔFFR 0.8 . Results : ΔFFR 0.8 corresponded inversely and linearly with the average transmural extent of infarction ( r 2 = 0.65, P < 0.001). We found that a transmural extent of infarction of 0.50 corresponded to a ΔFFR 0.8 threshold of 0.1, and had high sensitivity and specificity (100% and 94.4%, respectively). Conclusions : Using only an upstream pressure‐sensitive guidewire and a partially obstructing balloon during pharmacologic hyperemia, we were able to predict MRI myocardial viability with high accuracy after relief of epicardial stenosis. With further validation, this may prove a useful clinical prognostic tool after percutaneous intervention. © 2011 Wiley Periodicals, Inc.