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(Circulation. 2002;105:2482.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Coronary Thermodilution to Assess Flow Reserve

Validation in Humans

Nico H.J. Pijls, MD, PhD; Bernard De Bruyne, MD, PhD; Leif Smith, PhD; Wilbert Aarnoudse, MD; Emanuele Barbato, MD; Jozef Bartunek, MD, PhD; G. Jan Willem Bech, MD; Frans Van De Vosse, PhD

From the Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands (N.H.J.P., W.A., G.J.W.B.); the Department of Cardiology, Cardiovascular Center, Aalst, Belgium (B.D.B., E.B., J.B.); Radi Medical Systems, Uppsala, Sweden (L.S.); and the Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (N.H.J.P., F.V.D.V.).

Correspondence to Dr Nico H.J. Pijls, Department of Cardiology, Catharina Hospital, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. E-mail nico.pijls{at}inter.nl.net

Background— Guide wire–based simultaneous measurement of fractional flow reserve (FFR) and coronary flow reserve (CFR) is important to understand microvascular disease of the heart. The aim of this study was to investigate the feasibility of simultaneous measurement of FFR and CFR by one pressure-temperature sensor-tipped guide wire with the use of coronary thermodilution and to compare CFR by thermodilution (CFR_thermo) with simultaneously measured Doppler CFR (CFR_Doppl).

Methods and Results— In 103 coronary arteries in 50 patients, a pressure-temperature sensor-tipped 0.014-inch floppy guide wire and a 0.014-inch Doppler guide wire were introduced. Both normal vessels and a wide range of stenotic vessels were included. With 3 mL of saline at room temperature used as an indicator, by hand-injection, thermodilution curves in the coronary artery were obtained in triplicate, both at baseline and at intravenous adenosine-induced maximum hyperemia. After adequate curve-fitting, CFR_thermo was calculated from the ratio of inverse mean transit times and compared with CFR_Doppl calculated by velocities at hyperemia and baseline. Adequate sets of thermodilution curves and corresponding CFR_thermo could be obtained in 87% of the arteries versus 91% for Doppler CFR and 100% for FFR. CFR_thermo correlated fairly well to CFR_Doppl (CFR_thermo=0.84 CFR_Doppl+0.17; r=0.80; P<0.001), although individual differences of >20% between both indexes were seen in a quarter of all arteries.

Conclusions— This study shows the feasibility of simultaneous measurement of FFR (by coronary pressure) and CFR (by coronary thermodilution) in humans by one single guide wire in a practical and straightforward way and will facilitate assessment of microvascular disease.

Key Words: blood flow • stenosis • arteries • microcirculation • coronary artery disease

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