Author + information
- Received October 9, 2017
- Revision received December 21, 2017
- Accepted January 2, 2018
- Published online April 16, 2018.
- Rikuta Hamaya, MDa,
- Taishi Yonetsu, MDa,
- Yoshihisa Kanaji, MDa,
- Eisuke Usui, MDa,
- Masahiro Hoshino, MDa,
- Masao Yamaguchi, MDa,
- Masahiro Hada, MDa,
- Yoshinori Kanno, MDa,
- Tadashi Murai, MDa,
- Kenzo Hirao, MD, PhDb and
- Tsunekazu Kakuta, MD, PhDa,∗ ()
- aDivision of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
- bDepartment of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
- ↵∗Address for correspondence:
Dr. Tsunekazu Kakuta, Department of Cardiology, Tsuchiura Kyodo General Hospital, 4-4-1 Otsuno, Tsuchiura City, Ibaraki, 300-0028, Japan.
Objectives This study aimed to evaluate the feasibility and efficacy of pressure-temperature sensor–tipped wire–derived coronary flow capacity (PTW-CFC) for assessing flow impairment and prognosis.
Background CFC provides an integrated coronary physiological assessment in which coronary flow reserve and coronary flow during hyperemia are organized.
Methods A total of 643 native de novo lesions for which physiological assessments were performed using a PressureWire (St. Jude Medical, St. Paul, Minnesota) in patients with stable coronary artery disease were identified. The entire cohort was stratified by PTW-CFC according to the well-validated thresholds of coronary flow reserve and the corresponding inverse of thermodilution-derived mean transit time under hyperemia. Coronary physiological indices and the prevalence of major adverse cardiac events (MACE) were assessed according to PTW-CFC categories. Furthermore, in patients who underwent percutaneous coronary intervention (PCI), post-PCI PTW-CFC categorization was performed and clinical outcomes were evaluated.
Results PTW-CFC categorization efficiently discriminated previously validated coronary physiological parameters for functional stenosis severity and microvascular dysfunction. MACE rates during follow-up (2.4 years) were significantly associated with advanced impairment of PTW-CFC except for severely reduced PTW-CFC. In the subgroup analysis of patients with severely reduced pre-PCI PTW-CFC who underwent successful PCI, MACE incidence was significantly frequent in patients with post-PCI non-normal PTW-CFC compared with those with post-PCI normal PTW-CFC.
Conclusions PTW-CFC mapping was feasible, provided accurate stratifications of coronary flow impairment, and may predict MACE. Combined analysis involving PTW-CFC and fractional flow reserve may enrich the clinical implication of integrated coronary physiology and may help predict prognosis.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 9, 2017.
- Revision received December 21, 2017.
- Accepted January 2, 2018.
- 2018 American College of Cardiology Foundation