Intracoronary pressures to predict myocardial viability in patients with ischemic left ventricular dysfunction

• Published in: Catheterization and cardiovascular interventions 2022-02, Vol.99 (2), p.271-279
• Main Authors: Marchese, Nicola, Barbato, Emanuele, Di Gioia, Giuseppe, Stanislao, Mario, Valle, Guido, Copetti, Massimiliano, Pellegrini, Giorgia, Vigna, Carlo
• Format: Article
• Language: English
• Subjects: Coronary Angiography; Coronary Stenosis - complications; Coronary Stenosis - diagnostic imaging; Coronary Vessels; FFR—fractional flow reserve; Fractional Flow Reserve, Myocardial; Heart; heart failure; Humans; Ischemia; Myocardium; PCI—percutaneous coronary intervention; Predictive Value of Tests; Pressure; Severity of Illness Index; Stenosis; Territory; Treatment Outcome; Ventricle; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Viability
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.30065

To investigate the role of intracoronary pressure parameters in the assessment of viability in the myocardium subtending a significant coronary stenosis. In patients with ischemic left ventricular dysfunction, the presence of myocardial viability is related to the expected benefits derived from coronary revascularization. Intracoronary pressure wire‐based measurements were performed in 64 coronary lesions of ≥50% stenosis severity of 59 patients with postischemic left ventricular dysfunction, segmental left ventricular wall motion abnormalities, and substantial viability in the myocardial territory subtending the investigated stenotic coronaries, defined as the percent summed rest score in the target territory (%SRStarget) ≤60% at the single‐photon emission tomography. Invasive pressure‐derived indexes like resting and hyperemic Pd/Pa, ΔPd/Pa, and %ΔPd/Pa (defined as the absolute difference and percent decrease between resting and hyperemic Pd/Pa respectively) were compared with %SRStarget. A significant correlation was found between ΔPd/Pa (Spearman's p: −0.760, p 80% viability with good sensitivity and specificity. Our study suggests that, in patients with postischemic left ventricular dysfunction and significant coronary stenosis, intracoronary pressures indexes like ΔPd/Pa and %ΔPd/Pa are able to predict the magnitude of downstream myocardial viability.