Author + information
- Received February 27, 2019
- Revision received July 5, 2019
- Accepted July 21, 2019
- Published online September 30, 2019.
- Carlos Collet, MDa,∗∗ (, )@ColletCarlos,
- Jeroen Sonck, MDa,b,∗,
- Bert Vandeloo, MDc,
- Takuya Mizukami, MD, PhDa,d,
- Bram Roosens, MD, PhDc,
- Stijn Lochy, MDc,
- Jean-Francois Argacha, MD, PhDc,
- Danny Schoors, MD, PhDc,
- Iginio Colaiori, MDa,
- Giuseppe Di Gioia, MDa,
- Monika Kodeboina, MDa,
- Hiroshi Suzuki, MD, PhDd,
- Marcel Van ’t Veer, MSc, PhDe,
- Jozef Bartunek, MD, PhDa,
- Emanuele Barbato, MD, PhDa,b,
- Bernard Cosyns, MD, PhDc and
- Bernard De Bruyne, MD, PhDa,f
- aCardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
- bDepartment of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
- cCentrum voor Hart- en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
- dDepartment of Cardiology, Showa University Fujigaoka Hospital, Kanagawa, Japan
- eDepartment of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
- fLausanne University Hospital, Lausanne, Switzerland
- ↵∗Address for correspondence:
Dr. Carlos Collet, Cardiovascular Center Aalst, OLV Clinic, Moorselbaan 164, Aalst, Belgium 9300.
Background Diffuse atherosclerosis is commonly observed in angiographically normal segments in patients with stable coronary artery disease (CAD). The distribution of epicardial resistance along the vessel can be evaluated using coronary physiology.
Objectives The purpose of this study was to characterize the pathophysiological patterns of CAD using invasive pressure pullbacks during continuous hyperemia.
Methods In this prospective, multicenter study of patients undergoing clinically-indicated coronary angiography due to stable angina, a pressure-wire pullback device was set at a speed of 1 mm/s. Based on coronary angiography and on the fractional flow reserve (FFR) pullback curve, the patterns of CAD were adjudicated as focal, diffuse, or a combination of both. The distribution of epicardial resistance was characterized using the hyperemic pullback pressure gradients (PPGs). The PPG index, a continuous metric based on the magnitude of pressure drop over 20 mm and on the extent of functional disease was computed to determine the pattern of CAD. Low PPG index indicates diffuse CAD.
Results A total of 158 vessels (n = 117) were included. Overall, 984,813 FFR values were used to generate 100 FFR pullback curves. Using coronary physiology, 36% of the vessel disease patterns were reclassified compared to angiography. The median of maximal PPG over 20 mm was 0.083 (interquartile range: 0.063 to 0.118) FFR units, and the mean extent of functional disease was 39.3 ± 21.3 mm. The mean PPG index was 0.58 ± 0.18 and differentiated pathophysiological focal and diffuse disease (p < 0.001).
Conclusions Pathophysiological patterns of CAD can be characterized by motorized hyperemic PPGs. The evaluation of the FFR pullback curve reclassified one-third of the vessels’ disease patterns compared with conventional angiography. The PPG index is a novel metric that quantifies the distribution of epicardial resistance and discriminates focal from diffuse CAD. (Physiological Patterns of Coronary Artery Disease; NCT03824600)
↵∗ Drs. Collet and Sonck contributed equally to this work. Dr. Collet has received research grants from Biosensor, Heart Flow, and Abbott Vascular; and has received consultancy fees from Heart Flow and Philips Volcano. Dr. Sonck has received research grant support from the Cardiopath PhD program. Dr. Mizukami has received consultancy fees from Heart Flow Inc. Dr. van't Veer has received speaker fees from Abbott Vascular; and has served as a consultant for Opsens. Dr. Barbato has received institutional grant support from Abbott Vascular, Boston Scientific, and Biotronik. Dr. De Bruyne’s institution, The Cardiovascular Center Aalst, has received grant support on his behalf from Abbott, Boston Scientific, Biotronik AG, and St. Jude Medical; has received consulting fees on his behalf from St. Jude Medical, Opsens, and Boston Scientific; and he is a shareholder for Siemens, GE, Bayer, Philips, HeartFlow, Edwards Lifesciences, and Ceyliad.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received February 27, 2019.
- Revision received July 5, 2019.
- Accepted July 21, 2019.
- 2019 American College of Cardiology Foundation
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