High-fidelity translesional pressure gradients during percutaneous transluminal coronary angioplasty: Correlation with quantitative coronary angiography

Abstract

A fiberoptic pressure sensor mounted on an 0.018-inch guidewire (Pressure Guide) was used to measure the transstenotic pressure gradient in 30 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with lesions considered suitable for quantitative coronary angiographic (QCA) assessment. The aim of the study was to correlate pressure gradients with parameters obtained with QCA. After intracoronary injection of 125 micrograms of nitroglycerin, multiple angiographic views were taken of the lesion. The Pressure Guide fiberoptic sensor was then positioned distal to the stenosis and the pressure gradients were recorded before and after PTCA. There was a significant correlation between mean pressure gradients (delta P) and percent diameter stenosis (r = 0.73; p < 0.001) and absolute stenosis diameter (r = -0.67; p < 0.001) and with percent area stenosis (r = 0.69; p < 0.001) and absolute stenosis area (r = -0.63; p < 0.001). The closest relationship, though, was found with stenotic flow reserve (SFR), which is an integrated parameter calculated from QCA. This relationship can be described by the equation: delta P = 65.2 - 12.6.SFR (r = -0.79; p < 0.001). With a measured gradient of > 15 mm Hg, the sensitivity was 94% and the specificity 96% to predict an SFR < 3.5. In conclusion, a statistically significant relationship could be found between stenosis pressure gradients and angiographic parameters in this study with lesions without complicated morphology. The independent information obtained by pressure gradient measurement may be of particular value in intermediately severe lesions or in stenoses where the angiographic assessment otherwise is difficult.