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J Am Coll Cardiol, 1998; 32:1272-1279
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Coronary collateral quantitation in patients with coronary artery disease using intravascular flow velocity or pressure measurements

Christian Seiler, MD, FACCa, Martin Fleisch, MDa, Ali Garachemani, MDa and Bernhard Meier, MD, FACCa

a Department of Cardiology, University Hospital, Bern, Switzerland

Manuscript received February 19, 1998; revised manuscript received June 17, 1998, accepted July 2, 1998.

Address for correspondence: Dr. Christian Seiler, Department of Cardiology, University Hospital, Inselspital, Freiburgstrasse, Bern, Switzerland
christian.seiler{at}insel.ch

Objectives. This study evaluated two methods for the quantitative measurement of collaterals using intracoronary (IC) blood flow velocity or pressure measurements.

Background. The extent of myocardial necrosis after coronary artery occlusion is substantially influenced by the collateral circulation. So far, qualitative methods have been available to assess the human coronary collateral circulation, thus restraining the conclusive investigation of, for example, therapies to promote collateral development.

Methods. Fifty-one patients with a coronary artery stenosis to be treated by percutaneous transluminal coronary angioplasty (PTCA) were investigated using IC PTCA guidewire-based Doppler and pressure sensors positioned distal to the stenosis. Simultaneous measurements of aortic pressure, IC velocity and pressure distal to the stenosis during and after PTCA provided the variables for calculating collateral flow indices (CFIv and CFIp) that express collateral flow as a fraction of flow via the patent vessel. Both CFIv and CFIp were compared with conventional methods for collateral assessment, among them ST-segment changes >1 mm on IC and surface electrocardiogram (ECG) at PTCA. Also, CFIv and CFIp were compared with each other.

Results. In 11 patients without ECG signs of ischemia during PTCA (sufficient collaterals), relative collateral flow amounted to 46% as determined by Doppler and pressure wire. Patients with insufficient collaterals (n = 40) had relative collateral flow values of 18%. Using a threshold of CFI = 30%, sufficient and insufficient collaterals could be diagnosed with 100% sensitivity and 93% specificity by IC Doppler, and 75% sensitivity and 92% specificity by IC pressure measurements. The agreement between Doppler and pressure measurements was good: CFIv = 0.08 + 0.8 CFIp, r = 0.80, p = 0.0001.

Conclusions. Intracoronary flow velocity or pressure measurements during routine PTCA represent an accurate and, at last, quantitative method for assessing the coronary collateral circulation in humans.

Abbreviations and Acronyms
  CAD = coronary artery disease
  CFIp = pressure-derived collateral flow index
  CFIv = velocity-derived collateral flow index
  CFVR = coronary flow velocity reserve
  CVP = central venous pressure
  IC = intracoronary
  Pao = mean aortic pressure
  Poccl = distal IC occlusive or coronary wedge pressure
  PTCA = percutaneous transluminal coronary angioplasty
  Vioccl = flow velocity time integral obtained distal to the occluded stenosis
  Viø-occl = flow velocity time integral obtained distal to the dilated stenosis




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