Thermodilution-derived volumetric resting coronary blood flow measurement in humans

Emanuele Gallinoro; Alessandro Candreva; Iginio Colaiori; Monika Kodeboina; Stephane Fournier; Olivier Nelis; Giuseppe Di Gioia; Jeroen Sonck; Marcel van 't Veer; Nico H.J. Pijls; Carlos Collet; Bernard de Bruyne

doi:10.4244/EIJ-D-20-01092

Thermodilution-derived volumetric resting coronary blood flow measurement in humans

Emanuele Gallinoro
, Alessandro Candreva
, Iginio Colaiori
, Monika Kodeboina
, Stephane Fournier
, Olivier Nelis
, Giuseppe Di Gioia
, Jeroen Sonck
, Marcel van 't Veer
, Nico H.J. Pijls
, Carlos Collet
, Bernard de Bruyne

Research output: Contribution to journal › Article › Academic › peer-review

61 Citations (Scopus)

Abstract

Background: Quantification of microvascular function requires the measurement of flow and resistance at rest and during hyperaemia. Continuous intracoronary thermodilution accurately measures coronary flow during hyperaemia. Aims: The aim of this study was to investigate whether continuous coronary thermodilution using lower infusion rates also enables volumetric coronary blood flow measurements (in mL/min) at rest. Methods: In 59 patients (88 arteries), the ratio of distal to proximal coronary pressure (Pd/Pa), as well as absolute blood flow (in mL/min) by continuous thermodilution, was recorded using a pressure/temperature guidewire. Saline was infused at rates of 10 and 20 mL/min. In 27 arteries, Doppler average peak velocity (APV) was measured simultaneously. Pd/Pa, APV, thermodilution-derived coronary flow reserve (CFRthermo) and coronary flow velocity reserve (CFVR) were assessed. In 10 arteries, simultaneous recordings were obtained at saline infusion rates of 6, 8, 10 and 20 mL/min. Results: Compared to baseline, saline infusion at 10 mL/min did not change Pd/Pa (0.95±0.05 versus 0.94±0.05, p=0.49) or APV (22±8 versus 23±8 cm/s, p=0.60); conversely, an infusion rate of 20 mL/min induced a decrease in Pd/Pa and an increase in APV. Stable thermodilution tracings were obtained during saline infusion at 8 and 10 mL/min, but not at 6 mL/min. Mean values of CFRthermo and CFVR were similar (2.78±0.91 versus 2.76±1.06, p=0.935) and their individual values correlated closely (r=0.89, 95% CI: 0.78-0.95, p<0.001). Conclusions: In addition to hyperaemic flow, continuous thermodilution can quantify absolute resting coronary blood flow; therefore, it can be used to calculate coronary flow reserve and microvascular resistance reserve.

Original language	English
Pages (from-to)	E672-E679
Journal	EuroIntervention
Volume	17
Issue number	8
DOIs	https://doi.org/10.4244/EIJ-D-20-01092
Publication status	Published - 1 Oct 2021

Funding

M. Kodeboina, S. Fournier, G. Di Gioia and J. Sonck are supported by a research grant from the CardioPaTh PhD programme. G. Di Gioia is financially supported by UniNA and Compagnia di San Paolo in the frame of the STAR programme. C. Collet reports receiving research grants from Biosensors, HeartFlow Inc., Shockwave Medical, Pie Medical, Siemens, Medis Medical Imaging and Abbott Vascular, and consultancy fees from Opsens, Boston Scientific, Medyria, HeartFlow Inc., and Philips/Volcano. B. De Bruyne has received grants from Abbott Vascular, Boston Scientific and Biotronik, institutional consulting fees from Abbott and Boston Scientific, and is a shareholder in Philips, Siemens, GE, Bayer, HeartFlow, Edwards Lifesciences, and Ceyliad. S. Fournier declares speaker fees from Bayer, Amgen, and Biotronik, and consulting fees (advisory boards) from Bayer, and CathWorks. M. van ’t Veer declares speaker fees from Abbott. N. Pijls declares institutional research grants from Abbott and Hexacath, consultancy for Abbott, Opsens and General Electric, and minor equity in Philips, ASML, HeartFlow and GE. The other authors have no conflicts of interest to declare.

Keywords

Fractional flow reserve
Other techniques
Stable angina
Coronary Circulation
Heart
Thermodilution
Humans
Blood Flow Velocity
Diagnostic Techniques, Cardiovascular
Hyperemia
Coronary Vessels/diagnostic imaging
Arteries

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10.4244/EIJ-D-20-01092

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@article{62ffd3aa7ee449aa9ca896018201fbab,

title = "Thermodilution-derived volumetric resting coronary blood flow measurement in humans",

abstract = "Background: Quantification of microvascular function requires the measurement of flow and resistance at rest and during hyperaemia. Continuous intracoronary thermodilution accurately measures coronary flow during hyperaemia. Aims: The aim of this study was to investigate whether continuous coronary thermodilution using lower infusion rates also enables volumetric coronary blood flow measurements (in mL/min) at rest. Methods: In 59 patients (88 arteries), the ratio of distal to proximal coronary pressure (Pd/Pa), as well as absolute blood flow (in mL/min) by continuous thermodilution, was recorded using a pressure/temperature guidewire. Saline was infused at rates of 10 and 20 mL/min. In 27 arteries, Doppler average peak velocity (APV) was measured simultaneously. Pd/Pa, APV, thermodilution-derived coronary flow reserve (CFRthermo) and coronary flow velocity reserve (CFVR) were assessed. In 10 arteries, simultaneous recordings were obtained at saline infusion rates of 6, 8, 10 and 20 mL/min. Results: Compared to baseline, saline infusion at 10 mL/min did not change Pd/Pa (0.95±0.05 versus 0.94±0.05, p=0.49) or APV (22±8 versus 23±8 cm/s, p=0.60); conversely, an infusion rate of 20 mL/min induced a decrease in Pd/Pa and an increase in APV. Stable thermodilution tracings were obtained during saline infusion at 8 and 10 mL/min, but not at 6 mL/min. Mean values of CFRthermo and CFVR were similar (2.78±0.91 versus 2.76±1.06, p=0.935) and their individual values correlated closely (r=0.89, 95\% CI: 0.78-0.95, p<0.001). Conclusions: In addition to hyperaemic flow, continuous thermodilution can quantify absolute resting coronary blood flow; therefore, it can be used to calculate coronary flow reserve and microvascular resistance reserve.",

keywords = "Fractional flow reserve, Other techniques, Stable angina, Coronary Circulation, Heart, Thermodilution, Humans, Blood Flow Velocity, Diagnostic Techniques, Cardiovascular, Hyperemia, Coronary Vessels/diagnostic imaging, Arteries",

author = "Emanuele Gallinoro and Alessandro Candreva and Iginio Colaiori and Monika Kodeboina and Stephane Fournier and Olivier Nelis and \{Di Gioia\}, Giuseppe and Jeroen Sonck and \{van 't Veer\}, Marcel and Pijls, \{Nico H.J.\} and Carlos Collet and \{de Bruyne\}, Bernard",

note = "Funding Information: M. Kodeboina, S. Fournier, G. Di Gioia and J. Sonck are supported by a research grant from the CardioPaTh PhD programme. G. Di Gioia is financially supported by UniNA and Compagnia di San Paolo in the frame of the STAR programme. Funding Information: C. Collet reports receiving research grants from Biosensors, HeartFlow Inc., Shockwave Medical, Pie Medical, Siemens, Medis Medical Imaging and Abbott Vascular, and consultancy fees from Opsens, Boston Scientific, Medyria, HeartFlow Inc., and Philips/Volcano. B. De Bruyne has received grants from Abbott Vascular, Boston Scientific and Biotronik, institutional consulting fees from Abbott and Boston Scientific, and is a shareholder in Philips, Siemens, GE, Bayer, HeartFlow, Edwards Lifesciences, and Ceyliad. S. Fournier declares speaker fees from Bayer, Amgen, and Biotronik, and consulting fees (advisory boards) from Bayer, and CathWorks. M. van {\textquoteright}t Veer declares speaker fees from Abbott. N. Pijls declares institutional research grants from Abbott and Hexacath, consultancy for Abbott, Opsens and General Electric, and minor equity in Philips, ASML, HeartFlow and GE. The other authors have no conflicts of interest to declare. Publisher Copyright: {\textcopyright} Europa Digital \& Publishing 2021. All rights reserved.",

year = "2021",

month = oct,

day = "1",

doi = "10.4244/EIJ-D-20-01092",

language = "English",

volume = "17",

pages = "E672--E679",

journal = "EuroIntervention",

issn = "1774-024X",

publisher = "Europa Group",

number = "8",

}

TY - JOUR

T1 - Thermodilution-derived volumetric resting coronary blood flow measurement in humans

AU - Gallinoro, Emanuele

AU - Candreva, Alessandro

AU - Colaiori, Iginio

AU - Kodeboina, Monika

AU - Fournier, Stephane

AU - Nelis, Olivier

AU - Di Gioia, Giuseppe

AU - Sonck, Jeroen

AU - van 't Veer, Marcel

AU - Pijls, Nico H.J.

AU - Collet, Carlos

AU - de Bruyne, Bernard

N1 - Funding Information: M. Kodeboina, S. Fournier, G. Di Gioia and J. Sonck are supported by a research grant from the CardioPaTh PhD programme. G. Di Gioia is financially supported by UniNA and Compagnia di San Paolo in the frame of the STAR programme. Funding Information: C. Collet reports receiving research grants from Biosensors, HeartFlow Inc., Shockwave Medical, Pie Medical, Siemens, Medis Medical Imaging and Abbott Vascular, and consultancy fees from Opsens, Boston Scientific, Medyria, HeartFlow Inc., and Philips/Volcano. B. De Bruyne has received grants from Abbott Vascular, Boston Scientific and Biotronik, institutional consulting fees from Abbott and Boston Scientific, and is a shareholder in Philips, Siemens, GE, Bayer, HeartFlow, Edwards Lifesciences, and Ceyliad. S. Fournier declares speaker fees from Bayer, Amgen, and Biotronik, and consulting fees (advisory boards) from Bayer, and CathWorks. M. van ’t Veer declares speaker fees from Abbott. N. Pijls declares institutional research grants from Abbott and Hexacath, consultancy for Abbott, Opsens and General Electric, and minor equity in Philips, ASML, HeartFlow and GE. The other authors have no conflicts of interest to declare. Publisher Copyright: © Europa Digital & Publishing 2021. All rights reserved.

PY - 2021/10/1

Y1 - 2021/10/1

N2 - Background: Quantification of microvascular function requires the measurement of flow and resistance at rest and during hyperaemia. Continuous intracoronary thermodilution accurately measures coronary flow during hyperaemia. Aims: The aim of this study was to investigate whether continuous coronary thermodilution using lower infusion rates also enables volumetric coronary blood flow measurements (in mL/min) at rest. Methods: In 59 patients (88 arteries), the ratio of distal to proximal coronary pressure (Pd/Pa), as well as absolute blood flow (in mL/min) by continuous thermodilution, was recorded using a pressure/temperature guidewire. Saline was infused at rates of 10 and 20 mL/min. In 27 arteries, Doppler average peak velocity (APV) was measured simultaneously. Pd/Pa, APV, thermodilution-derived coronary flow reserve (CFRthermo) and coronary flow velocity reserve (CFVR) were assessed. In 10 arteries, simultaneous recordings were obtained at saline infusion rates of 6, 8, 10 and 20 mL/min. Results: Compared to baseline, saline infusion at 10 mL/min did not change Pd/Pa (0.95±0.05 versus 0.94±0.05, p=0.49) or APV (22±8 versus 23±8 cm/s, p=0.60); conversely, an infusion rate of 20 mL/min induced a decrease in Pd/Pa and an increase in APV. Stable thermodilution tracings were obtained during saline infusion at 8 and 10 mL/min, but not at 6 mL/min. Mean values of CFRthermo and CFVR were similar (2.78±0.91 versus 2.76±1.06, p=0.935) and their individual values correlated closely (r=0.89, 95% CI: 0.78-0.95, p<0.001). Conclusions: In addition to hyperaemic flow, continuous thermodilution can quantify absolute resting coronary blood flow; therefore, it can be used to calculate coronary flow reserve and microvascular resistance reserve.

AB - Background: Quantification of microvascular function requires the measurement of flow and resistance at rest and during hyperaemia. Continuous intracoronary thermodilution accurately measures coronary flow during hyperaemia. Aims: The aim of this study was to investigate whether continuous coronary thermodilution using lower infusion rates also enables volumetric coronary blood flow measurements (in mL/min) at rest. Methods: In 59 patients (88 arteries), the ratio of distal to proximal coronary pressure (Pd/Pa), as well as absolute blood flow (in mL/min) by continuous thermodilution, was recorded using a pressure/temperature guidewire. Saline was infused at rates of 10 and 20 mL/min. In 27 arteries, Doppler average peak velocity (APV) was measured simultaneously. Pd/Pa, APV, thermodilution-derived coronary flow reserve (CFRthermo) and coronary flow velocity reserve (CFVR) were assessed. In 10 arteries, simultaneous recordings were obtained at saline infusion rates of 6, 8, 10 and 20 mL/min. Results: Compared to baseline, saline infusion at 10 mL/min did not change Pd/Pa (0.95±0.05 versus 0.94±0.05, p=0.49) or APV (22±8 versus 23±8 cm/s, p=0.60); conversely, an infusion rate of 20 mL/min induced a decrease in Pd/Pa and an increase in APV. Stable thermodilution tracings were obtained during saline infusion at 8 and 10 mL/min, but not at 6 mL/min. Mean values of CFRthermo and CFVR were similar (2.78±0.91 versus 2.76±1.06, p=0.935) and their individual values correlated closely (r=0.89, 95% CI: 0.78-0.95, p<0.001). Conclusions: In addition to hyperaemic flow, continuous thermodilution can quantify absolute resting coronary blood flow; therefore, it can be used to calculate coronary flow reserve and microvascular resistance reserve.

KW - Fractional flow reserve

KW - Other techniques

KW - Stable angina

KW - Coronary Circulation

KW - Heart

KW - Thermodilution

KW - Humans

KW - Blood Flow Velocity

KW - Diagnostic Techniques, Cardiovascular

KW - Hyperemia

KW - Coronary Vessels/diagnostic imaging

KW - Arteries

UR - https://www.scopus.com/pages/publications/85102151839

U2 - 10.4244/EIJ-D-20-01092

DO - 10.4244/EIJ-D-20-01092

M3 - Article

C2 - 33528358

AN - SCOPUS:85102151839

SN - 1774-024X

VL - 17

SP - E672-E679

JO - EuroIntervention

JF - EuroIntervention

IS - 8

ER -

Thermodilution-derived volumetric resting coronary blood flow measurement in humans

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