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Effect of elective percutaneous coronary intervention on hyperemic absolute coronary blood flow volume and microvascular resistance

Session Poster session 1

Speaker Masahiro Hada

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : Y Kanaji (Tsuchiura,JP), T Yonetsu (Tsuchiura,JP), T Murai (Tsuchiura,JP), E Usui (Tsuchiura,JP), M Hoshino (Tsuchiura,JP), M Yamaguchi (Tsuchiura,JP), T Nida (Tsuchiura,JP), M Hada (Tsuchiura,JP), S Ichijo (Tsuchiura,JP), Y Kanno (Tsuchiura,JP), T Kakuta (Tsuchiura,JP)

Y. Kanaji1 , T. Yonetsu1 , T. Murai1 , E. Usui1 , M. Hoshino1 , M. Yamaguchi1 , T. Nida1 , M. Hada1 , S. Ichijo1 , Y. Kanno1 , T. Kakuta1 , 1Tsuchiura Kyodo Hospital, cardiovascular department - Tsuchiura - Japan ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 202

Background: The purpose of PCI is to increase coronary flow by targeting epicardial coronary artery stenosis. However, the hemodynamics involved in the relationship between absolute coronary blood flow volume (ABF) and absolute myocardial resistance (MR) are complex and the effect of PCI on their changes remains unclear.

Objectives: The aim of this study was to investigate the differences in hyperemic ABF and MR before and after elective PCI in patients with stable angina pectoris using a novel thermodilution method.

Methods: We investigated 28 vessels (RCA 9, LAD 18, LCx 1) from 28 patients with stable angina pectoris undergoing elective PCI. ABF was measured pre and post PCI, using a pressure-temperature sensor-equipped wire, based on a novel thermodilution method with a continuous saline infusion of 20 mL/min through a proximally located microcatheter in the target vessel. MR equals distal coronary perfusion pressure divided by ABF at hyperemia. Conventional FFR was measured before and after PCI in the target vessels deemed to be culprit by angiography, with >50% diameter stenosis.

Results: Stenting was performed successfully in all these patients. No significant complications were observed during the physiologic examinations and ABF and MR were determined successfully. FFR increased significantly after PCI (from 0.70 [0.65–0.75] to 0.88 [0.85–0.95]). In the total cohort, ABF also increased significantly (from 137.8 [86.3–180.8] to 173.3 [137.9–234.3] mL/min; increase: 52.8 [9.7–80.8] mL/min), although 6 territories showed a decrease in ABF despite successful PCI and FFR improvement. No significant relationship was detected between these increases. MR decreased in 11 vessels and increased in 17. The increase in ABF after PCI was significantly associated with the change in MR (r=0.69, p<0.01). The change in MR after PCI was inversely correlated with pre-PCI MR (r=0.62, p<0.01).

Conclusions: The main findings of the present study were as follows: (1) the novel quantification technique for measuring ABF and MR was feasible and safe in patients treated with elective PCI; (2) in the present cohort, 22 territories (78.6%) showed an increase in ABF after PCI, whereas 6 (21.4%) territories presented a decrease; and (3) significant serial change in hyperemic MR was observed after PCI at individual territory level, although there was no significant difference in MR between pre- and post-PCI in the total cohort; (4) an ABF increase after PCI was significantly associated with the change in MR; (5) the change in MR after PCI significantly correlated with pre-PCI MR. The technique of a novel thermodilution method using a continuous intracoronary infusion of saline allowed us to elucidate the changes in ABF and MR after PCI. Serial changes in MR significantly influenced the increase or decrease in ABF after elective PCI. Further studies using this novel method may shed new light on coronary hemodynamics.

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