Introduction
Materials and methods
Study design and subject selection
iFR and FFR measurements
Angiographic analysis
Electrocardiogram measurements
Data analysis
Statistical analysis
Results
Clinical characteristics
Number of patients (male) | 42(32) |
Age, years | 70.1 ± 9.9 |
Body weight, kg | 64.8 ± 14.4 |
Body height, cm | 161.9 ± 7.7 |
BMI, kg/m2 | 24.5 ± 3.9 |
Laboratory data | |
Hb, g/dL | 13.5 ± 1.7 |
Cr, mg/dL | 0.86 ± 0.21 |
eGFR, ml/min/m2 | 65.7 ± 14.7 |
Na, meq/L | 141 ± 2 |
K, meq/L | 4.3 ± 0.3 |
Cl, meq/L | 104 ± 2 |
QCA | |
Lesion length, mm | 16.0 ± 8.7 |
Reference diameter, mm | 2.5 ± 0.6 |
Minimal luminal diameter, mm | 1.4 ± 0.5 |
Diameter stenosis, % | 42.4 ± 16.3 |
Left ventricular ejection fraction, % | 64.5 ± 7.8 |
Medical history, % | |
Hypertension | 39(92.6) |
Diabetes mellitus | 14(33.3) |
Dyslipidemia | 34(81.0) |
Current Smoking | 11(26.2) |
Prior myocardial infarction (RCA/LAD/LCX) | 8/3/2 |
Hemodynamic and ECG changes after ATP and papaverine infusions
Baseline | ATP | Papaverine | P value (baseline vs ATP) | P value (baseline vs Papaverine) | P value (ATP vs papaverine) | |
---|---|---|---|---|---|---|
Pd, mmHg | 87 ± 16 | 67 ± 14 | 68 ± 15 | < 0.001 | < 0.001 | 0.571 |
Pa, mmHg | 94 ± 15 | 84 ± 14 | 84 ± 14 | < 0.001 | < 0.001 | 0.756 |
FFR (Pd/Pa) | 0.92 ± 0.05 | 0.81 ± 0.09 | 0.81 ± 0.09 | < 0.001 | < 0.001 | 0.551 |
Hyperemic iFR | 0.73 ± 0.13 | 0.73 ± 0.1 | 0.296 | |||
APV, cm/ s (n = 17) | 20 ± 6 | 42 ± 17 | 43 ± 18 | 0.297 | ||
CFR | 2.2 ± 0.7 | 2.2 ± 0.7 | 0.269 | |||
HSR | 0.48 ± 0.25 | 0.43 ± 0.19 | 0.300 | |||
HMR | 1.9 ± 1.0 | 1.8 ± 0.7 | 0.343 | |||
PQ, msec | 162 ± 4 | 166 ± 26 | 161 ± 26 | < 0.001 | 0.843 | 0.274 |
RR, msec | 929 ± 23 | 854 ± 141 | 868 ± 143 | < 0.001 | 0.015 | 0.356 |
QT, msec | 417 ± 8 | 419 ± 45 | 408 ± 83 | 0.003 | 0.476 | 0.348 |
QTU, msec | 443 ± 12 | 470 ± 85 | 526 ± 75 | 0.006 | < 0.001 | < 0.001 |
QTUc, sec1/2 | 0.467 ± 0.013 | 0.511 ± 0.013 | 0.570 ± 0.090 | 0.002 | < 0.001 | < 0.001 |
Relationship between QTU prolongation and physiological assessment
Group 1 (QTUc ATP/papaverine ratio: 0.674–0.905) (n = 21), CFR (n = 12) | Group 2 (QTUc ATP/papaverine ratio: 0.915–1.113) (n = 21), CFR(n = 5) | |||||
---|---|---|---|---|---|---|
Age, years | 71.9 ± 8.6 | 68.4 ± 11.0 | ||||
Gender (male %) | 15/6 (71.4%) | 17/4 (81.0%) | ||||
BMI, kg/m2 | 24.1 ± 4.1 | 25.0 ± 3.8 | ||||
ATP | Papaverine | P value | ATP | Papaverine | P value | |
Electrocardiogram data | ||||||
PQ interval, msec | 172 ± 29 | 167 ± 28 | 0.455 | 159 ± 22 | 155 ± 24 | 0.433 |
RR interval, msec | 827 ± 151 | 819 ± 124 | 0.729 | 880 ± 129 | 916 ± 146 | 0.080 |
QT interval, msec | 409 ± 46 | 408 ± 93 | 0.968 | 429 ± 42 | 409 ± 73 | 0.091 |
QTU, msec | 425 ± 67 | 535 ± 72 | < 0.001 | 515 ± 78 | 518 ± 79 | 0.758 |
QTUc, sec1/2 | 0.470 ± 0.066 | 0.594 ± 0.079 | < 0.001 | 0.552 ± 0.084 | 0.545 ± 0.089 | 0.454 |
Pressure and flow data | ||||||
Pd, mmHg | 66 ± 15 | 66 ± 15 | 0.862 | 69 ± 13 | 71 ± 14 | 0.365 |
Pa, mmHg | 82 ± 16 | 81 ± 14 | 0.754 | 85 ± 13 | 86 ± 14 | 0.500 |
FFR value | 0.81 ± 0.10 | 0.81 ± 0.10 | 0.906 | 0.81 ± 0.09 | 0.82 ± 0.08 | 0.217 |
Hyperemic iFR value | 0.74 ± 0.14 | 0.71 ± 0.15 | 0.025 | 0.73 ± 0.12 | 0.74 ± 0.12 | 0.009 |
APV, cm/s | 45 ± 17 | 47 ± 18 | 0.238 | 34 ± 15 | 33 ± 13 | 0.529 |
CFR | 2.2 ± 0.8 | 2.3 ± 0.7 | 0.219 | 2.0 ± 0.8 | 2.0 ± 0.7 | 0.778 |
HSR | 0.46 ± 0.25 | 0.40 ± 0.19 | 0.140 | 0.54 ± 0.26 | 0.49 ± 0.21 | 0.233 |
HMR | 1.8 ± 1.1 | 1.6 ± 0.7 | 0.271 | 2.3 ± 0.6 | 2.3 ± 0.5 | 0.839 |
Comparable group − 0.05 < iFR_a–iFR_p < 0.05 | Lower iFR_p group 0.05 < iFR_a–iFR_p | P value | |
---|---|---|---|
n | 35 | 7 | |
Age, years old | 69.4 ± 9.7 | 73.7 ± 11.1 | 0.299 |
Gender (male %) | 26 (74.3%) | 6 (85.7%) | 0.461 |
BMI, kg/m2 | 24.4 ± 4.1 | 24.8 ± 3.0 | 0.838 |
ATP | |||
Pd, mmHg | 68 ± 15 | 64 ± 7 | 0.504 |
Pa, mmHg | 84 ± 15 | 81 ± 7 | 0.696 |
FFR | 0.81 ± 0.09 | 0.80 ± 0.12 | 0.657 |
iFR_a | 0.73 ± 0.13 | 0.74 ± 0.16 | 0.896 |
Papaverine | |||
Pa, mmHg | 85 ± 15 | 79 ± 9 | 0.357 |
Pd, mmHg | 69 ± 15 | 63 ± 12 | 0.278 |
FFR | 0.82 ± 0.09 | 0.79 ± 0.12 | 0.557 |
iFR_p | 0.74 ± 0.12 | 0.65 ± 0.18 | 0.096 |
ATP | |||
QTU interval, msec | 482 ± 85 | 409 ± 60 | 0.037 |
QTUc, sec1/2 | 0.52 ± 0.087 | 0.461 ± 0.057 | 0.095 |
Papaverine | |||
QTU interval, msec | 521 ± 72 | 552 ± 90 | 0.338 |
QTUc, sec1/2 | 0.558 ± 0.084 | 0.629 ± 0.079 | 0.046 |
QTUc_a/QTUc_p | 0.939 ± 0.117 | 0.734 ± 0.036 | < 0.0001 |
Lesion length, mm | 16.2 ± 9 | 14.6 ± 7.1 | 0.650 |
Reference diameter, mm | 2.6 ± 0.6 | 2.3 ± 0.8 | 0.263 |
Minimal luminal diameter, mm | 1.45 ± 0.5 | 1.4 ± 0.5 | 0.792 |
Diameter stenosis, % | 43 ± 17.2 | 39.4 ± 10.5 | 0.599 |