Published online before print October 4, 2004, doi: 10.1161/01.CIR.0000143893.18451.0E
(Circulation. 2004;110:2137-2142.)
© 2004 American Heart Association, Inc.
Congenital Heart Disease |
Epicardial Stenosis Severity Does Not Affect Minimal Microcirculatory Resistance
From the Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands (W.A., N.H.J.P.); Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, Calif (W.F.F.); Cardiovascular Center, OLV-Clinic, Aalst, Belgium (G.M., B.D.B.); and the Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands (W.A., M.G., F.v.d.V., M.R., N.H.J.P.).
Correspondence to Nico H.J. Pijls, MD, PhD, Department of Cardiology, Catharina Hospital, Michelangelolaan 2, PO Box 1350, 5602 ZA Eindhoven, The Netherlands. E-mail nico.pijls{at}inter.nl.net
Received January 22, 2004; de novo received April 2, 2004; accepted May 23, 2004.
Background— Whether minimal microvascular resistance of the myocardium is affected by the presence of an epicardial stenosis is controversial. Recently, an index of microcirculatory resistance (IMR) was developed that is based on combined measurements of distal coronary pressure and thermodilution-derived mean transit time. In normal coronary arteries, IMR correlates well with true microvascular resistance. However, to be applicable in the case of an epicardial stenosis, IMR should account for collateral flow. We investigated the feasibility of determining IMR in humans and tested the hypothesis that microvascular resistance is independent of epicardial stenosis.
Methods and Results— Thirty patients scheduled for percutaneous coronary intervention were studied. The stenosis was stented with a pressure guidewire, and coronary wedge pressure (Pw ) was measured during balloon occlusion. After successful stenting, a short compliant balloon with a diameter 1.0 mm smaller than the stent was placed in the stented segment and inflated with increasing pressures, creating a 10%, 50%, and 75% area stenosis. At each of the 3 degrees of stenosis, fractional flow reserve (FFR) and IMR were measured at steady-state maximum hyperemia induced by intravenous adenosine. A total of 90 measurements were performed in 30 patients. When uncorrected for Pw, an apparent increase in microvascular resistance was observed with increasing stenosis severity (IMR=24, 27, and 37 U for the 3 different degrees of stenosis; P<0.001). In contrast, when Pwis appropriately accounted for, microvascular resistance did not change with stenosis severity (IMR=22, 23, and 23 U, respectively; P=0.28).
Conclusions— Minimal microvascular resistance does not change with epicardial stenosis severity, and IMR is a specific index of microvascular resistance when collateral flow is properly taken into account.
Key Words: coronary disease • microcirculation • pressure
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