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Intracoronary pressure measurement differences between anterior and posterior coronary territories

Unterschiede intrakoronarer Druckmessungen zwischen anterioren und posterioren Versorgungsgebieten

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Abstract

Introduction

Intracoronary pressure measurements have improved assessment of angiographic intermediate coronary stenoses. Methodically, pressure equalization and actual measurements are frequently performed at different height levels, depending on the particular coronary territory analyzed. Considering a hypothetical influence of hydrostatic pressure and the supine position of the patient, differences in the results of intracoronary measurements between anterior and posterior vessels seem likely. The purpose of this study was to compare the results of intracoronary pressure measurements between anterior and posterior coronary territories.

Methods

Intracoronary pressure measurements of 214 coronary stenoses in 158 patients were analyzed. Fractional flow reserve (FFR) was measured in all stenosis and instantaneous wave-free ratio (iFR) in 197 stenoses in 144 patients.

Results

Both FFR (0.79 vs. 0.87, p < 0.001) and iFR values (0.86 vs. 0.94, p < 0.001) were significantly higher in posterior compared to anterior coronary vessels. Patients with only anterior or posterior lesions did not differ regarding clinical or lesion characteristics, in particular coronary stenosis severity (62.5 vs. 61.6 %, p = 0.27).

Conclusions

Results of intracoronary measurements were systematically higher in the posterior coronary vessels when compared with anterior vessels. This phenomenon was independent of coronary stenosis severity or any clinical characteristics in our study population.

Zusammenfassung

Einleitung

Intrakoronare Druckmessungen haben die Beurteilbarkeit angiographisch intermediärer Koronarstenosen verbessert. Abhängig vom untersuchten koronaren Versorgungsgebiet erfolgen Druckabgleich und tatsächliche Messung regelhaft auf unterschiedlichen Höhenniveaus. Unter Berücksichtigung eines hypothetischen Einflusses des hydrostatischen Drucks sowie der Rückenlage des Patienten wären Unterschiede der Ergebnisse intrakoronarer Druckmessungen zwischen anterioren und posterioren Gefäße plausibel. Ziel dieser Studie war daher ein Vergleich der Ergebnisse intrakoronarer Druckmessungen zwischen anterioren und posterioren koronaren Versorgungsgebieten.

Methoden

Intrakoronare Druckmessungen an 214 Koronarstenosen von 158 Patienten wurden analysiert. Die fraktionelle Flussreserve (FFR) wurde bei allen Stenosen gemessen, die „instantaneous wave-free ratio“ (iFR) bei 197 Stenosen von 144 Patienten.

Ergebnisse

Sowohl FFR- (0,79 vs. 0,87; p < 0,001) als auch iFR-Werte (0,86 vs. 0,94; p < 0,001) waren signifikant höher in posterioren als in anterioren Koronargefäßen. Patienten mit ausschließlich anterioren oder posterioren Läsionen unterschieden sich nicht hinsichtlich klinischer oder morphologischer Merkmale, insbesondere des Schweregrads der Koronarstenosen (62,5 % vs. 61,6 %; p = 0,27).

Schlussfolgerung

Die Ergebnisse intrakoronarer Druckmessungen sind in posterioren Koronargefäßen systematisch höher als in anterioren Gefäßen. Dieses Phänomen war in unserer Studienpopulation unabhängig vom Schweregrad der Koronarstenose oder irgendeinem anderen klinischen Merkmal.

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Authors and Affiliations

  1. Klinik für Kardiologie, Klinikum Oldenburg, European Medical School Oldenburg-Groningen, Carl von Ossietzky Universität Oldenburg, Rahel-Straus-Str. 10, 26133, Oldenburg, Germany

    T. Härle, S. Meyer, F. Vahldiek & A. Elsässer

  2. Medizinische Klinik II, Gemeinschaftsklinikum Koblenz-Mayen, Koblenz, Germany

    W. Bojara

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  1. T. Härle
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Correspondence to T. Härle.

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Conflict of interest

T. Härle and W. Bojara report research relationship with a for profit organization (Volcano Corp.) during the conduct of the study. S. Meyer, F. Vahldiek, and A. Elsässer state that they have no competing interest.

This article does not contain any studies with human participants or animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Härle, T., Meyer, S., Bojara, W. et al. Intracoronary pressure measurement differences between anterior and posterior coronary territories. Herz 42, 395–402 (2017). https://doi.org/10.1007/s00059-016-4471-z

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  • DOI: https://doi.org/10.1007/s00059-016-4471-z

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