Coronary Artery Disease, Coronary Microvascular Dysfunction
Conditions
Keywords
Coronary Artery Disease, Coronary Physiology, Index of Microcirculatory Resistance (IMR)
Brief summary
When performing coronary angiography in a stable situation, the identification of an intermediate coronary lesion (between 50 and 70%) is common, and requires additional functional evaluation. The gold standard for this evaluation is Fractional Flow Reserve (FFR). FFR is a flow ratio transformed into a pressure ratio by simplification, neglecting some parameters, especially microcirculatory resistance. The aim of this study is to investigate hemodynamic and structural assessment induced in specific conditions, and their repercussion on functional assessment by FFR to implement the diagnostic approach and personalize it for each patient.
Interventions
None listed
Sponsors
University Hospital, Brest
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Intermediate coronary lesion (between 50 and 70%)
Exclusion criteria
* Hemodynamic instability * Adenosine hypersensitivity * Asthma * Severe chronic obstructive pulmonary disease * Long QTc * Wolff parkinson white * High degree atriovenricular block * Left-right shunt * Carotid artery stenosis with hemodynamic insufficiency * Pregnancy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Index of Microcirculatory Resistance (IMR) | During coronary angiography | IMR = Pd x Tmn at maximal hyperhemia Normal range \< 25 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Coronary Flow Reserve (CFR) | During coronary angiography | CFR = Hyperhemic flow / Resting flow Normal value \> 2 |
| Resting Full cycle Ratio (RFR) | During coronary angiography | Lowest Pd/Pa value in systole and diastole (mean of 5 consecutive cardiac cycles) Normal value \> 0.80 |
| Quantitative Flow Ratio (QFR) | During coronary angiography | Normal value \> 0.80 |
| Fractional Flow Reserve (FFR) | During coronary angiography | FFR = Pd/Pa at maximal hyperhemia Normal value \> 0.80 |
| Death | 12 months | — |
| Angina pectoris (CCS) | 12 months | Grade I : Angina with strenuous or rapid or prolonged exertion at work or recreation Grade II : Slight limitation of ordinary activity Grade III : Marked limitation of ordinary physical activity Grade IV : Inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest |
| Angio-IMR | During coronary angiography | Estimated hyperemic Pa × angio-FFR × \[vessel length/(K × Vdiastole)\] Normal value \< 25 |
Countries
France
Outcome results
None listed