coronary pressure:
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Book |
| Language: | English |
| Published: |
Dordrecht [u.a.]
Kluwer
1997
|
| Series: | Developments in cardiovascular medicine
195 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XVII, 344 S. Ill. |
| ISBN: | 0792346726 |
Staff View
MARC
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| 245 | 1 | 0 | |a coronary pressure |c by Nico H. J. Pijls and Bernard D Bruyne |
| 264 | 1 | |a Dordrecht [u.a.] |b Kluwer |c 1997 | |
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| 336 | |b txt |2 rdacontent | ||
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| 490 | 1 | |a Developments in cardiovascular medicine |v 195 | |
| 650 | 7 | |a Bloeddruk |2 gtt | |
| 650 | 7 | |a Coronaire bloedvaten |2 gtt | |
| 650 | 7 | |a Coronairsclerose |2 gtt | |
| 650 | 4 | |a Blood Flow Velocity | |
| 650 | 4 | |a Blood Pressure | |
| 650 | 4 | |a Blood pressure |x Measurement | |
| 650 | 4 | |a Coronary Circulation | |
| 650 | 4 | |a Coronary Vessels |x physiology | |
| 650 | 4 | |a Coronary Vessels |x physiopathology | |
| 650 | 4 | |a Coronary arteries |x Stenosis |x Diagnosis | |
| 650 | 4 | |a Coronary circulation | |
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Record in the Search Index
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| adam_text | Table of Contents
List of Abbreviations xvii
1. Introduction 1
1.1 Historical overview. 1
1.2 How to use this book. 2
1.3 Acknowledgements. 3
2. The coronary circulation 5
2.1 The coronary tree. 5
2.1.1 The arterial system. 5
2.1.2 Capillaries. 8
2.1.3 Collaterals. 8
2.2 Coronary flow mechanics. 10
2.3 Regulation of myocardial blood flow. 10
2.3.1 Autoregulation. 12
2.3.2 Extravascular coronary compression. 13
2.3.3 Neural regulation. 14
2.3.4 Coronary endothelium. 14
2.4 The concept of flow reserve. 16
2.4.1 Reactive hyperemia. 16
2.4.2 Minimal coronary resistance. 16
2.4.3 Coronary flow reserve. 18
3. Introduction to invasive assessment of the coronary
circulation 25
3.1 Morphological approaches. 25
3.1.1 Quantitative coronary angiography. 25
3.1.2 Intracoronary ultrasound. 30
3.1.3 Intracoronary angioscopy. 33
3.2 Functional approaches. 34
3.2.1 Myocardial videodensitometry. 34
3.2.2 Coronary flow velocity measurement. 3 5
3.2.3 Coronary pressure measurement. 39
4. Fractional flow reserve 49
From Coronary Pressure to Coronary Flow 49
4.1 Introduction. 49
4.2 Prerequisites for coronary pressure measurement. 50
4.3 Myocardial Fractional Flow Reserve. 51
4.4 Unique features of Myocardial Fractional Flow Reserve 59
4.5 Coronary Fractional Flow Reserve and fractional
collateral blood flow. 60
4.6 Limitations of Fractional Flow Reserve. 69
4.6.1 Microvascular disease. 69
4.6.2 Extravascular compression, zero flow pressure,
and vascular capacitance. 70
4.6.3 Coronary steal. 70
4.6.4 Left ventricular hypertrophy and previous myocardial
infarction. 71
4.7 Mathematical derivation and scientific background of
the pressure flow equations. 72
5. Practical set up of coronary pressure measurement 81
5.1 Set up in the catheterization laboratory. 81
5.1.1 Pressure transducers. 81
5.1.2 Medications. 82
5.1.3 Catheters. 83
5.2 Pressure monitoring guide wires. 83
5.2.1 Fluid filled pressure monitoring guide wires. 83
5.2.2 Micromanometer tipped guide wires. 86
5.3 Performance of the procedure. 90
5.3.1 Verification of equal pressures in the ascending aorta 90
5.3.2 Crossing the stenosis. 91
5.3.3 Induction of maximum hyperemia. 93
5.3.4 Pull back curve. 93
5.3.5PTCAandstenting. 94
5.3.6 Control for drift or other mistakes. 95
5.4 Maximum hyperemic stimuli. 96
5.4.1 Intracoronary versus intravenous stimuli. 96
5.4.2 Intracoronary papaverine. 97
5.4.3 Intracoronary adenosine. 97
5.4.4 Intravenous adenosine. 100
5.4.5 Intravenous ATP. 102
5.4.6 Intravenous dipyridamole. 103
XI
5.5 Pitfalls in coronary pressure measurement. 105
5.5.1 Use of balloon catheters or hypotubes instead of wires. 105
5.5.2 Incorrect height of the pressure transducer. 109
5.5.3 Reversed or paradoxical gradient. 109
5.5.4 Guiding catheter with sideholes. 109
5.5.5 Damping of pressure by the guiding catheter. 114
5.5.6 Special problems associated with hollow wires. 114
5.5.7 Proportionality of Pd and Pa. 115
5.5.8 Drift. 115
5.6 Influence of the presence of a guide wire across the lesion
on stenosis hemodynamics. 116
5.7 Safety of intracoronary pressure measurement. 117
6. Validation of fractional flow reserve in animals 121
6.1 Introduction. 121
6.2 Methods. 122
6.2.1 The pressure flow model. 122
6.2.2 Animal instrumentation. 123
6.2.3 Experimental protocol. 126
6.2.4 Data processing and statistical analysis. 126
6.3 Results. 127
6.3.1 Hemodynamic observations and the relation between
mean arterial pressure and coronary wedge pressure. 127
6.3.2 Calculated versus measured FFR and contribution of
collateral flow to total flow. 128
6.4 Discussion. 133
6.4.1 Advantages of fractional flow reserve. 133
6.4.2 From coronary pressure to coronary flow. 134
6.4.3 Limitations of the model. 135
6.4.4 Clinical implications. 138
7. Validation of fractional flow reserve in humans 143
7.1 Study design. 143
7.2 Rationale for validating pressure derived fractional flow
reserve by PET measurements of relative flow reserve. 146
7.3 Feasibility of fractional flow reserve calculation. 151
7.4 Myocardial flow by PET versus pressure derived indexes. 15 7
Xll
7.5 Myocardial blood flow versus quantitative coronary
angiography. 153
7.6 Conclusions. 155
8. Independence of fractional flow reserve of
hemodynamic loading conditions 157
8.1 Study design. 157
8.2 Feasibility of the measurements. 160
8.3 Reproducibility under basal hemodynamic conditions. 161
8.4 Effects of hemodynamic changes. 163
8.4.1 Changes in heart rate. 163
8.4.2 Changes in blood pressure. 163
8.4.3 Changes in contractility. 167
8.5 Reproducibility of translesional pressure gradient. 168
8.6 Comments. 169
8.7 Fractional flow reserve and the fluid dynamic equation. 172
8.8 Clinical implications. 176
9. Fractional flow reserve in normal coronary arteries 179
9.1 Introduction. 179
9.2 Fractional Flow reserve in normal coronary arteries. 180
9.3 FFRm ,0 in apparently normal contralateral coronary
arteries in patients with remote coronary artery disease. 184
10. Fractional flow reserve to distinguish significant
stenosis 189
Cut off values to detect reversible ischemia
10.1 Rationale for cut off values of invasive indexes. 189
10.2 Relation between FFRmj,0 and exercise induced myocardial
ischemia. Part I: Lower Threshold value of FFRm H, not
associated with inducible ischemia. 192
10.3 Relation between FFRmyo and exercise induced myocardial
ischemia. Part II: Upper threshold value of FFRmy0
associated with inducible ischemia. 198
10.4 Practical use of the cut off value of 0.75 in diagnostic
catheterization. 206
10.5 Considerations with respect to the critical cut off value
of 0.75 and some specific pathologic conditions. 208
Xlll
10.5.1 The cut off value of 0.75 in a physiologic perspective. 208
10.5.2 ¥¥Rmyo after myocardial infarction. 209
10.5.3 FFRmyo in the presence of microvascular disease. 210
10.5.4 FFRm ,o in case of left ventricular hypertrophy. 211
10.5.5 More than one stenosis within a coronary artery. 212
11. Comparison of fractional flow reserve to non
invasive tests to detect reversible ischemia. 221
11.1 The limited accuracy of non invasive tests to identify
inducible ischemia. 221
11.2 Design of the study. 222
11.2.1 Study population. 222
11.2.2 Outlines of the study protocol. 222
11.2.3 Exercise testing and Thallium scintigraphy. 223
11.2.4 Dobutamine stress echocardiography. 224
11.2.5 Pressure measurements and calculation of FFRm H. 224
11.2.6 On line clinical decision making, based upon
FFRmyo. 224
11.3 Definition of a gold standard of inducible ischemia
by combination of the non invasive tests. 225
11.4 Results. 226
11.4.1 Procedural and clinical results. 226
11.4.2 Comparison of myocardial fractional flow reserve
to the ischemic gold standard. 226
11.4.3 Follow up of the patients with FFRmvn 0.75. 230
11.5 Discussion. 230
11.5.1 The reliability of FFRm ,o for clinical decision making. 230
11.5.2 Methodological considerations for the composite
ischemic standard. 232
11.5.3 Clinical implications. 233
12. Assessment of collateral blood flow by coronary
pressure measurement 237
12.1 Assessment of collateral circulation. 237
12.2 Fractional collateral blood flow. 237
12.3 Calculation of fractional collateral blood flow in clinical
practice. 240
12.4 Some further aspects of fractional collateral flow. 243
XIV
12.4.1 The constant relation between Pa, Pv, and Pw. 244
12.4.2 Maximum hyperemia at coronary occlusion. 244
12.4.3 Is it necessary to measure venous pressure for
collateral flow assessment ? 245
12.4.4 Collateral flow at different degrees of stenosis. 246
12.5 Potential of recruitable collateral blood flow to predict
future ischemic events. 247
13. Fractional flow reserve for evaluation of coronary
interventions 261
13.1 Evaluation of PTC A result by ¥¥Rmyo 261
13.2 Relation between post PTCA ¥¥Rmyo and restenosis rate. 262
13.3 Fractional flow reserve after stent implantation. 264
13.3.1 ¥¥Rmyt as a specific index of epicardial conductance. 264
13.3.2 Evaluation of complete stent deployment by ¥¥Rmyo. 265
13.3.3 Relation between ¥¥Rmyo and intravascular
ultrasound. 266
13.4 Guidelines and recommendations. 270
14. Myocardial fractional flow reserve and clinical
outcome 273
14.1 Introduction. 273
14.2 Retrospective analysis of patients outcome after deferred
angioplasty based on ¥¥Rmyo 274
14.3 Prospective analysis of ¥¥Rmyo based decision making
to perform or defer a coronary intervention. 282
15. Clinical cases 287
15.1 Intermediate stenosis. 288
15.2 Difficult coronary anatomy. 296
15.3 Identification of the culprit lesion. 302
15.4 Diffuse disease. 306
15.5 Left main disease. 310
15.6 Epicardial versus microvascular disease. 314
15.7 Two stenoses in one vessel. 316
15.8 Protection by collaterals. 321
15.9 Evaluation of PTC A. 323
15.10 Evaluation of adequate stent deployment. 329
AV
16. Conclusions and perspectives for the future 333
Index. 341
|
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| id | DE-604.BV019592170 |
| illustrated | Illustrated |
| indexdate | 2024-07-09T20:01:00Z |
| institution | BVB |
| isbn | 0792346726 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-012928878 |
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| physical | XVII, 344 S. Ill. |
| publishDate | 1997 |
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| publisher | Kluwer |
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| series | Developments in cardiovascular medicine |
| series2 | Developments in cardiovascular medicine |
| spelling | Pijls, Nico H. Verfasser aut coronary pressure by Nico H. J. Pijls and Bernard D Bruyne Dordrecht [u.a.] Kluwer 1997 XVII, 344 S. Ill. txt rdacontent n rdamedia nc rdacarrier Developments in cardiovascular medicine 195 Bloeddruk gtt Coronaire bloedvaten gtt Coronairsclerose gtt Blood Flow Velocity Blood Pressure Blood pressure Measurement Coronary Circulation Coronary Vessels physiology Coronary Vessels physiopathology Coronary arteries Stenosis Diagnosis Coronary circulation Bruyne, Bernard de Verfasser aut Developments in cardiovascular medicine 195 (DE-604)BV000000660 195 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=012928878&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Pijls, Nico H. Bruyne, Bernard de coronary pressure Developments in cardiovascular medicine Bloeddruk gtt Coronaire bloedvaten gtt Coronairsclerose gtt Blood Flow Velocity Blood Pressure Blood pressure Measurement Coronary Circulation Coronary Vessels physiology Coronary Vessels physiopathology Coronary arteries Stenosis Diagnosis Coronary circulation |
| title | coronary pressure |
| title_auth | coronary pressure |
| title_exact_search | coronary pressure |
| title_full | coronary pressure by Nico H. J. Pijls and Bernard D Bruyne |
| title_fullStr | coronary pressure by Nico H. J. Pijls and Bernard D Bruyne |
| title_full_unstemmed | coronary pressure by Nico H. J. Pijls and Bernard D Bruyne |
| title_short | coronary pressure |
| title_sort | coronary pressure |
| topic | Bloeddruk gtt Coronaire bloedvaten gtt Coronairsclerose gtt Blood Flow Velocity Blood Pressure Blood pressure Measurement Coronary Circulation Coronary Vessels physiology Coronary Vessels physiopathology Coronary arteries Stenosis Diagnosis Coronary circulation |
| topic_facet | Bloeddruk Coronaire bloedvaten Coronairsclerose Blood Flow Velocity Blood Pressure Blood pressure Measurement Coronary Circulation Coronary Vessels physiology Coronary Vessels physiopathology Coronary arteries Stenosis Diagnosis Coronary circulation |
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