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CLINICAL RESEARCH

Assessment of coronary flowreserve by coronary pressure measurement

Comparison with flow- or Velocity-Derived coronary flow reserve

Takashi Akasaka, MD^*,*, Atsushi Yamamuro, MD, Norio Kamiyama, MD^*, Yuji Koyama, MD^*, Maki Akiyama, MD^*, Nozomi Watanabe, MD^*, Yoji Neishi, MD^*, Tsutomu Takagi, MD, Evgeny Shalman, PhD, Chen Barak, PhD and Kiyoshi Yoshida, MD, FACC^*

^* Department of Cardiology, Kawasaki Medical School, Kurashiki City, Okayama, Japan
Department of Cardiology, Kobe General Hospital, Chuo-ku, Kobe, Japan
Florence Medical Ltd., Sharona Center, Kfar-Saba, Israel

Manuscript received April 23, 2002; revised manuscript received December 23, 2002, accepted January 30, 2003.

^* Reprint requests and correspondence: Dr. Takashi Akasaka, Department of Cardiology, Kawasaki Medical School, Matsushima 577, Kurashiki City, Okayama 701-0192, Japan.
akasaka{at}med.kawasaki-m.ac.jp

OBJECTIVES: This study sought to assess the reliability of pressure-derived coronary flow reserve (CFR) compared with flow- or velocity-derived CFR.

BACKGROUND: Coronary flow reserve has been reported to have important clinical implications for the evaluation and treatment of coronary artery disease.

METHODS: Using a pressure guide wire, coronary pressure distal to the stenosis was measured at rest and during hyperemia in seven dogs with various degrees of stenosis and in 30 patients with angina (29 and 34 stenoses in total, respectively). Pressure at the tip of the guiding catheter was also recorded with a fluid-filled transducer system. Pressure-derived CFR was calculated by the square root of the pressure gradient across the stenosis (P) during hyperemia divided by P at rest, using a proprietary software system. At the same time, coronary flow was monitored proximal to the stenosis with a flow meter in the experimental dogs, and coronary flow velocity distal to the stenosis was assessed using a Doppler guide wire in patients with angina. Flow-derived (or velocity-derived) CFR was compared with pressure-derived CFR.

RESULTS: Except for one stenosis that showed no P at rest, a significant correlation was obtained between pressure- and flow-derived CFR in the animal study (y = 1.05x – 0.03, r = 0.92, p = 0.0001). A significant correlation was also seen between pressure- and velocity-derived CFR in the human study, except in three stenoses with no resting P (y = 0.70x + 0.37, r = 0.85, p = 0.0001).

CONCLUSIONS: Similar to flow (or velocity) measurement, CFR can be assessed by pressure measurement, except in stenoses with minor resting P.

Abbreviations and Acronyms   APV = averaged peak velocity (time average of instantaneous spectral peak velocity)   CFR = coronary flow reserve   ECG = electrocardiogram   FFR = fractional flow reserve   LAD = left anterior descending coronary artery   P = pressure gradient across stenotic lesion

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