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CLINICAL STUDY: CORONARY ARTERY DISEASE

Pulse transmission coefficient: a novel nonhyperemic parameter for assessing the physiological significance of coronary artery stenoses

David Brosh, MD^*, Stuart T. Higano, MD, FACC^*, Marvin J. Slepian, MD, Hylton I. Miller, MD, Morton J. Kern, MD, FACC, Ryan J. Lennon, MS^||, David R. Holmes, Jr, MD, FACC^* and Amir Lerman, MD, FACC^*,*

^* Center for Coronary Physiology and Imaging, Cardiovascular Division, Mayo Clinic Foundation, Rochester, Minnesota, USA
Cardiovascular Division, University Medical Center, Tucson, Arizona, USA
Cardiovascular Division, Tel Aviv Medical Center, Tel Aviv, Israel
Cardiovascular Division, Saint Louis University, Saint Louis, Missouri, USA
^|| Section of Biostatistics, Mayo Clinic Foundation, Rochester, Minnesota, USA

Manuscript received September 4, 2001; revised manuscript received December 27, 2001, accepted January 2, 2002.

^* Reprint requests and correspondence: Dr. Amir Lerman, Cardiovascular Division, Cardiac Laboratory, Saint Marys Hospital, Mary Brigh 4-506, Mayo Clinic Foundation, 1216 Second Street Southwest, Rochester, Minnesota 55902, USA.
Lerman.Amir{at}Mayo.Edu

OBJECTIVES: We sought to test the hypothesis that the pulse transmission coefficient (PTC) can serve as a nonhyperemic physiologic marker for the severity of coronary artery stenosis in humans.

BACKGROUND: Coronary lesions may impair the transmission of pressure waves across a stenosis, potentially acting as a low-pass filter. The PTC is a novel nonhyperemic parameter that calculates the transmission of high-frequency components of the pressure signal through a stenosis. Thus, it may reflect the severity of the coronary artery stenosis. This study was designed to examine the correlation between PTC and fractional flow reserve (FFR) in patients with coronary artery disease.

METHODS: Pressure signals were obtained by pressure guidewire in 56 lesions (49 patients) in the nonhyperemic state and were analyzed with a new algorithm that identifies the high-frequency components in the pressure signal. The PTC was calculated as the ratio between the distal and proximal high-frequency components of the pressure waveform across the lesion. The FFR measurements were assessed with intracoronary adenosine.

RESULTS: There was a significant correlation between PTC and FFR (r = 0.81, p < 0.001). By using a receiver operating characteristic analysis, we identified a PTC < 0.60 (sensitivity 100%, specificity 98%) to be the optimal cutoff value for predicting an FFR < 0.75.

CONCLUSIONS: Pulse transmission coefficient is a novel nonhyperemic parameter for the physiologic assessment of coronary artery stenoses. It correlates significantly with FFR and may predict an FFR < 0.75 with high accuracy. Pulse transmission coefficient may be useful as an adjunct measurement to FFR, especially in patients with microcirculatory disease and impaired maximal hyperemia.

Abbreviations and Acronyms   ROC   CAD   coronary artery disease   FFR   fractional flow reserve   PTC   pulse transmission coefficient   QCA   quantitative coronary angiography   ROC   receiver operating characteristic