Abstract 16772: Percutaneous Coronary Intervention (PCI) Enhances Transmission of Accelerative Waves in Coronary Arteries
Background: Coronary Wave Intensity analysis (CWI) enables separation and quantification of proximal and distal originating waves in the coronary circulation. The systolic forward going compression wave and diastolic backward going suction wave predominantly accelerate coronary flow. We hypothesized that the peak intensity of these waves would be reduced distal to a coronary stenosis, proportionate to ischaemia severity predicted by Fractional Flow Reserve (FFR). Moreover, we sought to determine if augmentation of early diastolic suction contributed to enhanced flow following PCI.
Methods: Simultaneous intracoronary pressure and velocity measurement was performed during adenosine induced hyperemia in 17 patients with pressure / flow wires positioned distal to the target lesion. FFR was measured as the ratio of mean pressure distal to the lesion to mean aortic pressure. Coronary artery wave speed was calculated utilising the “Single point sum-of-squares” method. CWI profiles were generated. We calculated the peak amplitudes of both compression and suction waves distal to the lesion before and after PCI and correlated these to FFR.
Results: Significant correlations existed between FFR and peak intensity of both waves (R = 0.73 P = 0.001 and R = 0.55 P = 0.02 respectively) (Figure 1). Percentage increases in peak intensity of both waves after PCI was correlated with FFR (R = 0.61 P = 0.01 and R = 0.49 P = 0.046 respectively). Following target lesion PCI, peak intensities of both waves increased by a mean 170.4% and 226.6%.
Conclusions: Increased ischaemia severity (determined by FFR) was associated with proportionate reductions in peak intensity of the backward going suction wave and the forward going compression wave. The improvements seen in wave transmission post PCI were proportional to baseline FFR. These findings suggest that impaired early diastolic suction represents a major, previously unrecognised mechanism driving ischaemia in coronary artery disease.
- Coronary artery disease
- Percutaneous coronary intervention
- Blood flow
- Interventional cardiology
- © 2012 by American Heart Association, Inc.