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CLINICAL STUDY

The diastolic flow-pressure gradient relation in coronary stenoses in humans

Koen M. J. Marques, MD^*,*, Hugo J. Spruijt, MSEE^*, Christa Boer, PhD, Nico Westerhof, PhD, Cees A. Visser, MD, PhD, FACC^* and Frans C. Visser, MD, PhD^*

^* Cardiology, VU University Medical Center, Amsterdam, The Netherlands
Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands

Manuscript received August 28, 2001; revised manuscript received February 13, 2002, accepted February 26, 2002.

^* Reprint requests and correspondence: Dr. Koen Marques, VU University Medical Center, Department of Cardiology, De Boelelaan 1117, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
km.marques{at}VUmc.nl

OBJECTIVES: We assessed the feasibility and reproducibility of the instantaneous diastolic coronary flow velocity-pressure gradient relation to characterize different degrees of coronary stenoses.

BACKGROUND: Assessment of the hemodynamic significance of coronary stenoses can be difficult. Using sensor-tipped guidewires, various physiologic indexes can be determined in the catheterization laboratory. Each of the current methods, however, has limitations.

METHODS: After positioning a Doppler flow wire and a pressure wire distal of a coronary stenosis, the flow velocity signals and the proximal and distal pressure were sampled simultaneously, at baseline and after intracoronary administration of adenosine. The instantaneous diastolic flow velocity and pressure gradient of single cardiac cycles at baseline, at maximal and intermediate hyperemia were plotted. Data were fitted with a regression line using the equation: . Measurements were performed in 11 normal coronary arteries, 20 intermediate stenoses and in 7 severe stenoses before and after percutaneous transluminal coronary angioplasty plus stenting.

RESULTS: We found significant differences between normal coronary arteries, intermediate and severe stenoses. Percutaneous transluminal coronary angioplasty nearly normalized the highly abnormal flow-pressure gradient relation in the severe stenoses. A high degree of reproducibility was observed. In 3% of the measurements, analysis was not possible due to the occurrence of pressure drift or bad flow velocity signals.

CONCLUSIONS: It is feasible to assess the diastolic flow velocity-pressure gradient relation over a wide range of stenoses. It characterizes the hemodynamics of epicardial coronary stenoses and allows discrimination between normal coronary arteries, intermediate and severe stenoses.

Abbreviations and Acronyms   CFVR   coronary flow velocity reserve   FFR   fractional flow reserve   LAD   left anterior descending artery   LCX   left circumflex artery   PTCA   percutaneous transluminal coronary angioplasty   QCA   quantitative coronary angiography   rCFVR   relative coronary flow velocity reserve   v-dp   the instantaneous diastolic flow velocity-pressure gradient

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