期刊
EUROPEAN HEART JOURNAL
卷 37, 期 26, 页码 2069-2080出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehv626
关键词
Autoregulation; Microvascular resistance; Physiological Lesion assessment; Stenosis
资金
- Medical Research Council (UK)
- British Heart Foundation
- National Institute for Health Research Imperial Biomedical Research Centre
- Institute for Cardiovascular Research of the VU University of Amsterdam (ICaR-VU)
- VU University Medical Center
- MRC [G1100443] Funding Source: UKRI
- Academy of Medical Sciences (AMS) [AMS-SGCL11-Sen] Funding Source: researchfish
- Medical Research Council [G1100443] Funding Source: researchfish
- National Institute for Health Research [CL-2015-21-001] Funding Source: researchfish
Background Our understanding of human coronary physiological behaviour is derived from animal models. We sought to describe physiological behaviour across a large collection of invasive pressure and flow velocity measurements, to provide a better understanding of the relationships between these physiological parameters and to evaluate the rationale for resting stenosis assessment. Methods Five hundred and sixty-seven simultaneous intracoronary pressure and flow velocity assessments from 301 patients and results were analysed for coronary flow velocity, trans-stenotic pressure gradient (TG), and microvascular resistance (MVR). Measurements were made during baseline and hyperaemic conditions. The whole cardiac cycle and the diastolic wave-free period were assessed. Stenoses were assessed according to fractional flow reserve (FFR) and quantitative coronary angiography DS%. With progressive worsening of stenoses, from unobstructed angiographic normal vessels to those with FFR <= 0.50, hyperaemic flow falls significantly from 45 to 19 cm/s, P-trend < 0.001 in a curvilinear pattern. Resting flow was unaffected by stenosis severity and was consistent across all strata of stenosis (P-trend > 0.05 for all). Trans-stenotic pressure gradient rose with stenosis severity for both rest and hyperaemic measures (P-trend < 0.001 for both). Microvascular resistance declines with stenosis severity under resting conditions < 0.001), but was unchanged at hyperaemia (2.3 +/- 1.1 mmHg/cm/s; P-trend = 0.19). Conclusions With progressive stenosis severity, TG rises. However, white hyperaemic flow falls significantly, resting coronary flow is maintained by compensatory reduction of MVR, demonstrating coronary auto-regulation. These data support the translation of coronary physiological concepts derived from animals to patients with coronary artery disease and furthermore, suggest that resting pressure indices can be used to detect the haemodynamic significance of coronary artery stenoses.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据