Catheter-based measurements of absolute coronary blood flow and microvascular resistance feasibility, safety, and reproducibility in humans

Panagiotis Xaplanteris, Stephane Fournier, Daniëlle C.J. Keulards, Julien Adjedj, Giovanni Ciccarelli, Anastasios Milkas, Mariano Pellicano, Marcel Van’t Veer, Emanuele Barbato, Nico H.J. Pijls, Bernard De Bruyne

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Abstract

Background—The principle of continuous thermodilution can be used to calculate absolute coronary blood flow and microvascular resistance (R). The aim of the study is to explore the safety, feasibility, and reproducibility of coronary blood flow and R measurements as measured by continuous thermodilution in humans. Methods and Results—Absolute coronary flow and R can be calculated by thermodilution by infusing saline at room temperature through a dedicated monorail catheter. The temperature of saline as it enters the vessel, the temperature of blood and saline mixed in the distal part of the vessel, and the distal coronary pressure were measured by a pressure/temperature sensor-tipped guidewire. The feasibility and safety of the method were tested in 135 patients who were referred for coronary angiography. No significant adverse events were observed; in 11 (8.1%) patients, bradycardia and concomitant atrioventricular block appeared transiently and were reversed immediately on interruption of the infusion. The reproducibility of measurements was tested in a subgroup of 80 patients (129 arteries). Duplicate measurements had a strong correlation both for coronary blood flow (ρ=0.841, P<0.001; intraclass correlation coefficient=0.89, P<0.001) and R (ρ=0.780, P<0.001; intraclass correlation coefficient=0.89, P<0.001). In Bland–Altman plots, there was no significant bias or asymmetry. Conclusions—Absolute coronary blood flow (in L/min) and R (in mm Hg/L/min or Wood units) can be safely and reproducibly measured with continuous thermodilution. This approach constitutes a new opportunity for the study of the coronary microcirculation. (Circ Cardiovasc Interv. 2018;11:e006194. DOI: 10.1161/CIRCINTERVENTIONS.117.006194.)

Original languageEnglish
Article numbere006194
Number of pages8
JournalCirculation: Cardiovascular Interventions
Volume11
Issue number3
DOIs
Publication statusPublished - 1 Mar 2018

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Thermodilution
Catheters
Safety
Temperature
Pressure
Atrioventricular Block
Microcirculation
Bradycardia
Coronary Angiography
Blood Vessels
Coronary Vessels
Arteries

Keywords

  • Coronary angiography
  • Fractional flow reserve
  • Microvascular angina
  • Microvessels
  • Myocardial
  • Reproducibility of results
  • Temperature
  • Thermodilution

Cite this

Xaplanteris, Panagiotis ; Fournier, Stephane ; Keulards, Daniëlle C.J. ; Adjedj, Julien ; Ciccarelli, Giovanni ; Milkas, Anastasios ; Pellicano, Mariano ; Van’t Veer, Marcel ; Barbato, Emanuele ; Pijls, Nico H.J. ; De Bruyne, Bernard. / Catheter-based measurements of absolute coronary blood flow and microvascular resistance feasibility, safety, and reproducibility in humans. In: Circulation: Cardiovascular Interventions. 2018 ; Vol. 11, No. 3.
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title = "Catheter-based measurements of absolute coronary blood flow and microvascular resistance feasibility, safety, and reproducibility in humans",
abstract = "Background—The principle of continuous thermodilution can be used to calculate absolute coronary blood flow and microvascular resistance (R). The aim of the study is to explore the safety, feasibility, and reproducibility of coronary blood flow and R measurements as measured by continuous thermodilution in humans. Methods and Results—Absolute coronary flow and R can be calculated by thermodilution by infusing saline at room temperature through a dedicated monorail catheter. The temperature of saline as it enters the vessel, the temperature of blood and saline mixed in the distal part of the vessel, and the distal coronary pressure were measured by a pressure/temperature sensor-tipped guidewire. The feasibility and safety of the method were tested in 135 patients who were referred for coronary angiography. No significant adverse events were observed; in 11 (8.1{\%}) patients, bradycardia and concomitant atrioventricular block appeared transiently and were reversed immediately on interruption of the infusion. The reproducibility of measurements was tested in a subgroup of 80 patients (129 arteries). Duplicate measurements had a strong correlation both for coronary blood flow (ρ=0.841, P<0.001; intraclass correlation coefficient=0.89, P<0.001) and R (ρ=0.780, P<0.001; intraclass correlation coefficient=0.89, P<0.001). In Bland–Altman plots, there was no significant bias or asymmetry. Conclusions—Absolute coronary blood flow (in L/min) and R (in mm Hg/L/min or Wood units) can be safely and reproducibly measured with continuous thermodilution. This approach constitutes a new opportunity for the study of the coronary microcirculation. (Circ Cardiovasc Interv. 2018;11:e006194. DOI: 10.1161/CIRCINTERVENTIONS.117.006194.)",
keywords = "Coronary angiography, Fractional flow reserve, Microvascular angina, Microvessels, Myocardial, Reproducibility of results, Temperature, Thermodilution",
author = "Panagiotis Xaplanteris and Stephane Fournier and Keulards, {Dani{\"e}lle C.J.} and Julien Adjedj and Giovanni Ciccarelli and Anastasios Milkas and Mariano Pellicano and {Van’t Veer}, Marcel and Emanuele Barbato and Pijls, {Nico H.J.} and {De Bruyne}, Bernard",
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Catheter-based measurements of absolute coronary blood flow and microvascular resistance feasibility, safety, and reproducibility in humans. / Xaplanteris, Panagiotis; Fournier, Stephane; Keulards, Daniëlle C.J.; Adjedj, Julien; Ciccarelli, Giovanni; Milkas, Anastasios; Pellicano, Mariano; Van’t Veer, Marcel; Barbato, Emanuele; Pijls, Nico H.J.; De Bruyne, Bernard.

In: Circulation: Cardiovascular Interventions, Vol. 11, No. 3, e006194, 01.03.2018.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Catheter-based measurements of absolute coronary blood flow and microvascular resistance feasibility, safety, and reproducibility in humans

AU - Xaplanteris, Panagiotis

AU - Fournier, Stephane

AU - Keulards, Daniëlle C.J.

AU - Adjedj, Julien

AU - Ciccarelli, Giovanni

AU - Milkas, Anastasios

AU - Pellicano, Mariano

AU - Van’t Veer, Marcel

AU - Barbato, Emanuele

AU - Pijls, Nico H.J.

AU - De Bruyne, Bernard

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background—The principle of continuous thermodilution can be used to calculate absolute coronary blood flow and microvascular resistance (R). The aim of the study is to explore the safety, feasibility, and reproducibility of coronary blood flow and R measurements as measured by continuous thermodilution in humans. Methods and Results—Absolute coronary flow and R can be calculated by thermodilution by infusing saline at room temperature through a dedicated monorail catheter. The temperature of saline as it enters the vessel, the temperature of blood and saline mixed in the distal part of the vessel, and the distal coronary pressure were measured by a pressure/temperature sensor-tipped guidewire. The feasibility and safety of the method were tested in 135 patients who were referred for coronary angiography. No significant adverse events were observed; in 11 (8.1%) patients, bradycardia and concomitant atrioventricular block appeared transiently and were reversed immediately on interruption of the infusion. The reproducibility of measurements was tested in a subgroup of 80 patients (129 arteries). Duplicate measurements had a strong correlation both for coronary blood flow (ρ=0.841, P<0.001; intraclass correlation coefficient=0.89, P<0.001) and R (ρ=0.780, P<0.001; intraclass correlation coefficient=0.89, P<0.001). In Bland–Altman plots, there was no significant bias or asymmetry. Conclusions—Absolute coronary blood flow (in L/min) and R (in mm Hg/L/min or Wood units) can be safely and reproducibly measured with continuous thermodilution. This approach constitutes a new opportunity for the study of the coronary microcirculation. (Circ Cardiovasc Interv. 2018;11:e006194. DOI: 10.1161/CIRCINTERVENTIONS.117.006194.)

AB - Background—The principle of continuous thermodilution can be used to calculate absolute coronary blood flow and microvascular resistance (R). The aim of the study is to explore the safety, feasibility, and reproducibility of coronary blood flow and R measurements as measured by continuous thermodilution in humans. Methods and Results—Absolute coronary flow and R can be calculated by thermodilution by infusing saline at room temperature through a dedicated monorail catheter. The temperature of saline as it enters the vessel, the temperature of blood and saline mixed in the distal part of the vessel, and the distal coronary pressure were measured by a pressure/temperature sensor-tipped guidewire. The feasibility and safety of the method were tested in 135 patients who were referred for coronary angiography. No significant adverse events were observed; in 11 (8.1%) patients, bradycardia and concomitant atrioventricular block appeared transiently and were reversed immediately on interruption of the infusion. The reproducibility of measurements was tested in a subgroup of 80 patients (129 arteries). Duplicate measurements had a strong correlation both for coronary blood flow (ρ=0.841, P<0.001; intraclass correlation coefficient=0.89, P<0.001) and R (ρ=0.780, P<0.001; intraclass correlation coefficient=0.89, P<0.001). In Bland–Altman plots, there was no significant bias or asymmetry. Conclusions—Absolute coronary blood flow (in L/min) and R (in mm Hg/L/min or Wood units) can be safely and reproducibly measured with continuous thermodilution. This approach constitutes a new opportunity for the study of the coronary microcirculation. (Circ Cardiovasc Interv. 2018;11:e006194. DOI: 10.1161/CIRCINTERVENTIONS.117.006194.)

KW - Coronary angiography

KW - Fractional flow reserve

KW - Microvascular angina

KW - Microvessels

KW - Myocardial

KW - Reproducibility of results

KW - Temperature

KW - Thermodilution

UR - http://www.scopus.com/inward/record.url?scp=85053377955&partnerID=8YFLogxK

U2 - 10.1161/CIRCINTERVENTIONS.117.006194

DO - 10.1161/CIRCINTERVENTIONS.117.006194

M3 - Article

C2 - 29870386

AN - SCOPUS:85053377955

VL - 11

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 3

M1 - e006194

ER -