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Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease

Authors :
Christopher M, Cook
Yousif, Ahmad
James P, Howard
Matthew J, Shun-Shin
Amarjit, Sethi
Gerald J, Clesham
Kare H, Tang
Sukhjinder S, Nijjer
Paul A, Kelly
John R, Davies
Iqbal S, Malik
Raffi, Kaprielian
Ghada, Mikhail
Ricardo, Petraco
Firas, Al-Janabi
Grigoris V, Karamasis
Shah, Mohdnazri
Reto, Gamma
Rasha, Al-Lamee
Thomas R, Keeble
Jamil, Mayet
Sayan, Sen
Darrel P, Francis
Justin E, Davies
Medical Research Council (MRC)
Publication Year :
2018
Publisher :
Elsevier, 2018.

Abstract

BACKGROUND: Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). OBJECTIVES: The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD. METHODS: A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles. RESULTS: PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p

Details

Language :
English
Database :
OpenAIRE
Accession number :
edsair.pmid.dedup....3e7d0f642df8c4217940492fcba7b5b9