Association Between Pathophysiological Disease Pattern and an Increase in Absolute Coronary Flow Velocity After Elective Percutaneous Coronary Intervention

IF 1.9 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2025-08-28 DOI:10.1002/ccd.70122

Hikaru Shimosato, Eisuke Usui, Yoshihisa Kanaji, Masahiro Hada, Tatsuhiro Nagamine, Hiroki Ueno, Mirei Setoguchi, Kodai Sayama, Takahiro Watanabe, Takashi Mineo, Nobutaka Wakasa, Taishi Yonetsu, Tetsuo Sasano, Tsunekazu Kakuta

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引用次数: 0

Abstract

Background

Percutaneous coronary intervention (PCI) aims to restore myocardial perfusion by relieving flow-limiting lesions. While fractional flow reserve (FFR) guides PCI decision-making, the relationship between lesion pathophysiological patterns and post-PCI absolute flow improvement remains elusive. Recent evidence suggests that disease pattern—focal versus diffuse—impacts PCI outcomes. The quantitative flow ratio (QFR)-derived pullback pressure gradient (PPG) offers a wire-free method to characterize these patterns.

Aims

We investigated whether pre-PCI QFR-PPG index predicts absolute coronary flow velocity improvement, assessed by stress-transthoracic Doppler echocardiography (S-TDE), in elective PCI.

Methods

This single-center retrospective analysis included 118 consecutive patients who underwent elective FFR-guided PCI and pre- and post-PCI LAD flow assessment using S-TDE. The study was conducted using the institutional QFR-PPG database registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000056097). Pre-PCI QFR-PPG index was calculated to assess its association with post-PCI changes in coronary flow velocity.

Results

Post-PCI hyperemic diastolic peak velocity (hDPV) improved in 81.3% of patients, but 18.6% showed decreased values despite FFR improvement. The median % increase in hDPV was 30.3%. Patients with greater hDPV improvement (> 30%) had significantly lower pre-PCI FFR, lower pre-PCI hDPV, and higher QFR-PPG index. Multivariable logistic regression identified these three indices as independent predictors of flow improvement. ROC analysis and net reclassification improvement (NRI) supported incremental value of the QFR-PPG index over traditional metrics.

Conclusions

Pre-PCI QFR-PPG index, together with FFR and S-TDE-derived hDPV, predicts absolute flow improvement after PCI. This noninvasive, wire-free approach may help optimize revascularization decisions.

Abstract Image

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择期经皮冠状动脉介入治疗后病理生理疾病模式与冠状动脉绝对血流速度增加的关系

背景：经皮冠状动脉介入治疗（PCI）旨在通过缓解血流受限病变来恢复心肌灌注。虽然分数血流储备（FFR）指导PCI决策，但病变病理生理模式与PCI后绝对血流改善之间的关系仍然难以捉摸。最近的证据表明疾病模式-局灶性与弥漫性-影响PCI结果。定量流量比（QFR）衍生的回拉压力梯度（PPG）提供了一种无需电缆的方法来表征这些模式。目的：我们研究择期PCI术前QFR-PPG指数是否能预测经压力-经胸多普勒超声心动图（S-TDE）评估的绝对冠状动脉血流速度改善。方法：这项单中心回顾性分析包括118例连续患者，他们接受了选择性ffr引导的PCI和PCI前后使用S-TDE进行LAD血流评估。本研究使用在大学医院医学信息网络临床试验登记处（UMIN000056097）注册的机构QFR-PPG数据库进行。计算pci前QFR-PPG指数，评估其与pci后冠状动脉血流速度变化的相关性。结果：81.3%的患者pci后充血舒张峰值速度（hDPV）改善，但18.6%的患者FFR改善，但hDPV值下降。hDPV的中位数增长为30.3%。hDPV改善较大（约30%）的患者pci前FFR显著降低，pci前hDPV显著降低，QFR-PPG指数较高。多变量logistic回归确定这三个指标为血流改善的独立预测因子。ROC分析和净重分类改善（NRI）支持QFR-PPG指数比传统指标的增量值。结论：PCI前QFR-PPG指数、FFR和s - tde衍生hDPV可预测PCI后绝对血流改善。这种无创、无导线的方法有助于优化血运重建决策。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.