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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Keywords

  • Coronary angiography
  • Fractional flow reserve
  • Microvascular angina
  • Microvessels
  • Myocardial
  • Reproducibility of results
  • Temperature
  • Thermodilution
  • Predictive Value of Tests
  • Angina, Stable/diagnosis
  • Thermodilution/instrumentation
  • Humans
  • Acute Coronary Syndrome/diagnosis
  • Feasibility Studies
  • Microcirculation
  • Coronary Circulation
  • Reproducibility of Results
  • Vascular Resistance
  • Cardiac Catheters
  • Coronary Angiography
  • Coronary Artery Disease/diagnosis
  • Blood Flow Velocity
  • Cardiac Catheterization/instrumentation
  • Referral and Consultation
  • Coronary Vessels/diagnostic imaging

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