A novel equitation to predict the pressure derived collateral flow index in multiple sequential coronary stenoses
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ORIGINAL ARTICLE
A novel equitation to predict the pressure derived collateral flow index in multiple sequential coronary stenoses Yoshiaki Kawase • Naritatsu Saito • Shin Watanabe • Bingyuan Bao • Erika Yamamoto • Hiroki Watanabe • Hirooki Higami • Kenji Nakatsuma Takeshi Kimura • Hitoshi Matsuo
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Received: 4 August 2014 / Accepted: 24 December 2014 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2015
Abstract Coronary collateral circulation is an alternative source of blood supply to the myocardium when the original blood flow is not sufficient. The pressure derived collateral flow index (CFI) calculated with (Pw - Pv)/ (Pa - Pv) can be measured during angioplasty and predicts the outcome of the patients with ischemic heart disease. However, the necessity of occluding the coronary artery at maximum hyperemia hampers the wide spread use. We mathematically derived a new equation which calculates CFI in sequential stenoses. The present study aimed to validate the equation in an in vitro model of coronary circulation. The predicted CFI is calculated from the following equation: CFI = (FFRpre - FFRpost(1 - DFFR))/ (FFRpre ? DFFR - FFRpost). FFRpre/post is the FFR before and after the angioplasty. DFFR is the FFR gradient across the target stenosis. The experimental system consisted of a pump, systemic circulation, coronary circulation, and 5 constrictors placed in the coronary artery. A total of 30 different sequential coronary stenoses were randomly created and 30 different pressure data were obtained. The predicted CFI was compared with the true CFI. A close positive correlation (r = 0.90, p \ 0.0001) was found between the predicted CFI and the true CFI. The accuracy of the equation was demonstrated in an in vitro model of coronary circulation.
Y. Kawase H. Matsuo Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan N. Saito (&) S. Watanabe B. Bao E. Yamamoto H. Watanabe H. Higami K. Nakatsuma T. Kimura Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan e-mail: [email protected]
Keywords Collateral flow index Fractional flow reserve Sequential stenosis
Background and aims Coronary collaterals are an alternative source of blood supply to myocardium at risk for ischemia. The extent of collateral circulation is known to affect the clinical outcome of the patients with occlusive coronary disease. A well-developed collateral circulation has a protective effect on the patient with ischemic heart disease [1–4], despite the increase of restenosis ratio after percutaneous coronary intervention (PCI) [5, 6]. Intracoronary pressure measurement using a pressure wire enables functional assessment of collateral circulation by occluding the coronary artery and simultaneous measurements of mean arterial (Pa), coronary wedge pressure (Pw), and central venous pressure (Pv) at maximum hyperemia [7, 8]. The parameter calculated from (Pw - Pv)/(Pa - Pv) is called the pre
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