Author + information
- Received March 26, 2018
- Revision received June 7, 2018
- Accepted June 9, 2018
- Published online August 20, 2018.
- Christopher M. Cook, MBBS, BSca,
- Yousif Ahmad, BMBSa,
- James P. Howard, MB BChira,
- Matthew J. Shun-Shin, BM BCha,
- Amarjit Sethi, MBBS, PhDa,
- Gerald J. Clesham, MB BChir, PhDb,c,
- Kare H. Tang, MBBSb,
- Sukhjinder S. Nijjer, MB ChB, PhDa,
- Paul A. Kelly, MB ChB, MDb,
- John R. Davies, MBBS, PhDb,c,
- Iqbal S. Malik, MBBS, PhDa,
- Raffi Kaprielian, MBBS, MDa,
- Ghada Mikhail, MBBS, MDa,
- Ricardo Petraco, MD, PhDa,
- Firas Al-Janabi, MBBSb,c,
- Grigoris V. Karamasis, MDb,c,
- Shah Mohdnazri, MDb,c,
- Reto Gamma, MDb,
- Rasha Al-Lamee, MBBSa,
- Thomas R. Keeble, MBBS, MDb,c,
- Jamil Mayet, MB ChB, MD, MBAa,
- Sayan Sen, MBBS, PhDa,
- Darrel P. Francis, MB BChir, MA, MDa and
- Justin E. Davies, MD, PhDa,∗ (, )@imperialcollege@ImperialNHS
- aImperial College London, London, United Kingdom
- bEssex Cardiothoracic Centre, Basildon, United Kingdom
- cAnglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
- ↵∗Address for correspondence:
Dr. Justin E. Davies, The Hammersmith Hospital, B block South, 2nd floor, NHLI Cardiovascular Science, Du Cane Road, London W12 0NN, United Kingdom.
Background Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD).
Objectives The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD.
Methods A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles.
Results PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001).
Conclusions In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.
This study was funded in part by the National Institute for Health Research (NIHR) and Imperial College Healthcare NHS Trust Biomedical Research Centre. Drs. Cook (MR/M018369/1), Nijjer (G1100443), and Sen (G1000357) are Medical Research Council fellows. Dr. Howard is a Wellcome Trust fellow (212183/Z/18/Z). Drs. Petraco (FS/11/46/28861), Shun-Shin (FS/14/27/30752), J.E. Davies (FS/05/006), and Francis (FS 04/079) are British Heart Foundation fellows. Drs. Cook, Nijjer, Petraco, and Al-Lamee have received speaker’s honoraria from Philips Volcano. Dr. Sethi has been a consultant for Philips Volcano. Dr. Mikhail is course director of the annual Imperial Valve & Cardiovascular Course (IVCC), which is supported by Edwards Lifesciences, Abbott, Medtronic, Philips, Volcanp, Occulotech, Acist, Cordis, CryoLifeEuropa, and LivaNova. Dr. Keeble has received research grants from Philips Volcano. Dr. Mayet hold patents pertaining to iFR technology. Dr. Sen has received speaker honoraria from Philips Volcano, Pfizer, and AstraZeneca. Dr. J.E. Davies holds patents pertaining to iFR technology; and has been a consultant for and received research grants from Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 26, 2018.
- Revision received June 7, 2018.
- Accepted June 9, 2018.
- 2018 The Authors