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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

View larger version (22K): [in a new window]   Figure 1 Representative plots for the measured pressure signal and the filtered signal are depicted by solid and dotted lines, respectively. The difference between the two signals is more prominent at the dicrotic notch segment (A). The region of interest (ROI) (dotted rectangle) for the calculation of pulse transmission coefficient is defined where the change in pressure signal, which is the difference between the measured and the filtered signal (depicted at bottom), is maximum (B). BP = blood pressure.

View larger version (16K): [in a new window]   Figure 2 Linear correlation between pulse transmission coefficient (PTC) and fractional flow reserve (FFR). The correlation was highly significant with a high correlation coefficient. Separated by the cutoff values (dotted lines) of 0.75 and 0.60 for FFR and PTC, respectively, the scattered distribution of most data points is observed either in the right upper quadrant or in the left lower quadrant. This represents a good agreement between the two parameters both above and below the cutoff values.

View larger version (157K): [in a new window]   Figure 3 A representative coronary angiogram and simultaneous tracing of aortic and intracoronary trans-stenotic pressure signals in a 62-year-old man. The patient had angiographically intermediate stenosis (68% diameter stenosis) of the mid left anterior descending coronary artery (A and B; right anterior oblique and left anterior oblique coronary arteries projections, respectively). The pressure recordings in C were simultaneously obtained by the guiding catheter (fluid-filled) (solid line) and the pressure wire (dotted line), while the sensor of the pressure wire was located both proximal and distal to the lesion. Distal pressure recording was obtained both at baseline and during adenosine-induced hyperemia (C). When reached to maximal hyperemic state by administrating incremental dosages of adenosine, the calculated fractional flow reserve (FFR) was found to be 0.57. The distal pressure waveform in D (lower waveform) was significantly altered as compared with the baseline proximal signal (upper waveform). This is especially prominent with regard to the absence of the dicrotic notch in the distal waveform, indicating attenuation of the high-frequency components of the pressure waveform across the stenosis and resulting in a pulse transmission coefficient value of 0.32, which suggest, in accordance with the FFR value, a functionally significant lesion.Continued on next page.