Background The purpose of coronary revascularization in stable patients is anginal relief, yet there is no linear relationship between stenosis severity and clinical significance. A major factor in this complex lesion myocardium interaction is collateral flow. We aimed to define which collateral flow cut-offs separate asymptornatic from symptomatic patients during coronary occlusion. Methods Patients undergoing percutaneous transluminal coronary angioplasty for a single stenotic lesion were selected, collaterals were appraised angiographically, and fractional flow reserve was used during prolonged balloon occlusion to measure collateral flow index (FFRcoll). Changes in anginal symptoms, ST-T segment, and left ventricular wall motion were appraised before and during/ shortly after balloon dilation. Receiver-operating-characteristic curves and area under the curve were computed to identify the most appropriate FFRcoll cut-offs. Results Twenty consecutive patients were enrolled. At baseline, 10 patients had angiographic evidence of collaterals, whereas 10 had no angiographic evidence of collateral flow distal to the target lesion. FFRcoll had an excellent discriminatory performance for the presence of angiographic collaterals (area under the curve = 0.90, P = 0.003), a good discriminatory performance for the occurrence of angina (area under the curve = 0.80, P = 0.025), and a trend toward a good discriminatory performance for the occurrence of asynergy (area under the curve = 0.81, P = 0.06). On the basis of receiver-operating-characteristic curves, an FFRcoll cut-off greater than 0.26 could reliably distinguish patients with adequate collaterals (sensitivity = 0.90, specificity = 0.80), whereas a greater than 0.41 cut-off distinguished patients having angina or wall motion abnormalities from those remaining asymptomatic. Conclusion This study shows that distal collateral pressure greater than 41% of proximal perfusion pressure protects from anginal symptoms or regional systolic dysfunction during coronary occlusion, whereas a greater than 26% cutoff is more appropriate to identify angiographically evident collaterals ensuring distal myocardial viability. J Cardiovasc Med 9:1120-1126 (C) 2008 Italian Federation of Cardiology.

Appraising the pathophysiologic impact of coronary collaterals as measured by fractional flow reserve on symptoms and signs of myocardial ischemia / Claudio, Moretti; BIONDI ZOCCAI, Giuseppe; Filippo, Sciuto; Pierluigi, Omede; Morena L., Lucciola Mt; Walter Grosso, Marra; Gian Paolo, Trevi; Imad, Sheiban. - In: JOURNAL OF CARDIOVASCULAR MEDICINE. - ISSN 1558-2027. - 9:11(2008), pp. 1120-1126. [10.2459/jcm.0b013e32830c6c64]

Appraising the pathophysiologic impact of coronary collaterals as measured by fractional flow reserve on symptoms and signs of myocardial ischemia

BIONDI ZOCCAI, GIUSEPPE;
2008

Abstract

Background The purpose of coronary revascularization in stable patients is anginal relief, yet there is no linear relationship between stenosis severity and clinical significance. A major factor in this complex lesion myocardium interaction is collateral flow. We aimed to define which collateral flow cut-offs separate asymptornatic from symptomatic patients during coronary occlusion. Methods Patients undergoing percutaneous transluminal coronary angioplasty for a single stenotic lesion were selected, collaterals were appraised angiographically, and fractional flow reserve was used during prolonged balloon occlusion to measure collateral flow index (FFRcoll). Changes in anginal symptoms, ST-T segment, and left ventricular wall motion were appraised before and during/ shortly after balloon dilation. Receiver-operating-characteristic curves and area under the curve were computed to identify the most appropriate FFRcoll cut-offs. Results Twenty consecutive patients were enrolled. At baseline, 10 patients had angiographic evidence of collaterals, whereas 10 had no angiographic evidence of collateral flow distal to the target lesion. FFRcoll had an excellent discriminatory performance for the presence of angiographic collaterals (area under the curve = 0.90, P = 0.003), a good discriminatory performance for the occurrence of angina (area under the curve = 0.80, P = 0.025), and a trend toward a good discriminatory performance for the occurrence of asynergy (area under the curve = 0.81, P = 0.06). On the basis of receiver-operating-characteristic curves, an FFRcoll cut-off greater than 0.26 could reliably distinguish patients with adequate collaterals (sensitivity = 0.90, specificity = 0.80), whereas a greater than 0.41 cut-off distinguished patients having angina or wall motion abnormalities from those remaining asymptomatic. Conclusion This study shows that distal collateral pressure greater than 41% of proximal perfusion pressure protects from anginal symptoms or regional systolic dysfunction during coronary occlusion, whereas a greater than 26% cutoff is more appropriate to identify angiographically evident collaterals ensuring distal myocardial viability. J Cardiovasc Med 9:1120-1126 (C) 2008 Italian Federation of Cardiology.
2008
coronary artery disease; coronary collateral; fractional flow reserve; percutaneous coronary intervention
01 Pubblicazione su rivista::01a Articolo in rivista
Appraising the pathophysiologic impact of coronary collaterals as measured by fractional flow reserve on symptoms and signs of myocardial ischemia / Claudio, Moretti; BIONDI ZOCCAI, Giuseppe; Filippo, Sciuto; Pierluigi, Omede; Morena L., Lucciola Mt; Walter Grosso, Marra; Gian Paolo, Trevi; Imad, Sheiban. - In: JOURNAL OF CARDIOVASCULAR MEDICINE. - ISSN 1558-2027. - 9:11(2008), pp. 1120-1126. [10.2459/jcm.0b013e32830c6c64]
File allegati a questo prodotto
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/434097
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 2
  • ???jsp.display-item.citation.isi??? 2
social impact