Author + information
- Guus de Waard1,
- Christopher Cook2,
- Ricardo Petraco3,
- Sukhjinder Nijjer2,
- Tim van de Hoef4,
- Mauro Echavarria Pinto5,
- Sayan Sen3,
- Martijn Meuwissen6,
- Paul Knaapen7,
- Javier Escaned8,
- Jan Piek9,
- Niels van Royen10 and
- Justin Davies2
- 1VU University Medical Centre, Amsterdam, Netherlands
- 2Imperial College London, London, United Kingdom
- 3Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- 4Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands
- 5Hospital General ISSSTE, Queretaro, Querétaro, Mexico
- 6Breda Amphia Ziekenhuis, Breda, Netherlands
- 7VU University Medical Center, Amsterdam, Netherlands
- 8Hospital Clínico San Carlos, Madrid, Spain
- 9Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- 10Radboud University, Nijmegen, Netherland
Diastolic-systolic velocity ratio (DSVR) is an index to assess LAD stenoses and can be measured by transthoracic echocardiography or intracoronary Doppler flow velocity. The aims of this study were to determine the diagnostic accuracy of DSVR and to elucidate the underlying rationale of DSVR.
Simultaneous measurements of intracoronary pressure and Doppler flow velocity were acquired in 228 stable patients. Resting total vascular resistance was calculated both during mid-to-late diastole and systole and stratified according to stenosis and microvascular resistance. Patients were classified according to fractional flow reserve (FFR). In 39 patients, measurements after percutaneous coronary intervention (PCI) were analyzed.
DSVR shows good concordance with FFR at the ischemic threshold of 0.75 (C-statistic: 0.76 [95%CI: 0.69-0.82]) and with hyperemic stenosis resistance index at the threshold of 0.80 mmHg·cm-1·s (C-statistic: 0.75 [95%CI: 0.68-0.82]). The optimal cut-off value for DSVR is 1.74. DSVR gradually declines with worsening of FFR classification (Ptrend<0.001). DSVR has a close inverse correlation with the diastolic-systolic resistance ratio (r2=0.83, P<0.001). The difference between the systolic and diastolic stenosis resistance as a percentage of total vascular resistance gradually increases as FFR class worsens (Ptrend<0.001). After PCI, DSVR increased from 1.56±0.24 to 1.77±0.32, P<0.001.
DSVR shows satisfactory diagnostic accuracy. DSVR is decreased in stenoses because the higher stenosis resistance has more impact on diastole than on systole. Because DSVR can also be measured by transthoracic echocardiography, it represents a quick and inexpensive test to assess LAD stenoses without the need for contrast or pharmacological stress agents.
IMAGING: FFR and Physiologic Lesion Assessment