Abstract
The benefit of percutaneous coronary intervention (PCI) has been reported to be associated with functional stenosis severity defined by fractional flow reserve (FFR). This study aimed to investigate the predictive ability of preprocedural transthoracic Doppler echocardiography (TDE) for increased coronary flow. A total of 50 left anterior descending arteries (LAD) that underwent TDE examinations were analysed. Hyperaemic LAD diastolic peak velocity (hDPV) was used as a surrogate of volumetric coronary flow. The increase in coronary flow was evaluated by the metric of % hDPV-increase defined by 100× (post-PCI hDPV-pre-PCI hDPV)/pre-PCI hDPV. The two groups divided by the median value of % hDPV-increase were compared, and the determinants of a significant coronary flow increase defined as more than the median % hDPV-increase were explored. After PCI, FFR values improved in all cases. hDPV significantly increased from 53.0 to 76.0 mm/s (P < 0.01) and the median % hDPV-increase was 45%, while hDPV decreased in 10 patients. On multivariable analysis, pre-PCI FFR and hDPV were independent predictors of a significant coronary flow increase. Preprocedural TDE-derived hDPV provided significant improvement of identification of lesions that benefit from revascularisation with respect to significant coronary flow increase.
Highlights
The benefit of percutaneous coronary intervention (PCI) has been reported to be associated with functional stenosis severity defined by fractional flow reserve (FFR)
One patient was excluded because they showed a type 4A myocardial infarction, and another patient withdrew their consent before completing the postprocedural S-transthoracic Doppler echocardiography (TDE)
The FFR and pre-PCI Hyperaemic LAD diastolic peak velocity (hDPV) were significantly lower in the significant coronary flow increase group (FFR: 0.65 vs 0.73, P = 0.005; pre-PCI hDPV: 46.0 vs 67.0 cm/s, P = 0.001)
Summary
The benefit of percutaneous coronary intervention (PCI) has been reported to be associated with functional stenosis severity defined by fractional flow reserve (FFR). An increase in coronary flow to the ischaemic region is the most fundamental reason for revascularisation because the severity and extent of stress-induced myocardial ischaemia have been proposed to be the most important contributing factors of a better p rognosis[3,4] These findings suggest that the benefit of percutaneous coronary intervention (PCI) may be greater in patients with lesions showing lower FFR v alues[5], wherein a greater increase in coronary flow might be expected. The three-fold aim of the present study, using hDPV as a surrogate of volumetric coronary flow, was to (1) investigate the early changes in S-TDE-derived indices, such as hDPV and CFVR, in the left anterior descending coronary artery (LAD) after successful and uncomplicated PCI; (2) explore the determinants of the changes in LAD hDPV; and (3) assess whether preprocedural S-TDE-derived physiological indices can predict increased coronary flow after PCI, independent of FFR
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