[Measurement of fractional and coronary flow reserve using dual sensor guide wire].
OBJECTIVE
Fractional flow reserve and coronary flow reserve (CFR) are indices of the severity of coronary artery stenosis influenced by both epicardial and microcirculatory dysfunction. The CFR was measured using the new pressure guide wire with thermal sensor (dual sensor guide wire) on the basis of the thermodilution principle (CFR-thermo), and compared to the CFR as measured by the Doppler method (CFR-Doppler), and the relationships were evaluated between CFR-thermo, fractional flow reserve and stress myocardial scintigraphy.


RESULTS
CFR-thermo and CFR-Doppler were measured in 14 patients (20 vessels) by the dual sensor guide wire and Doppler guide wire, respectively. A significant positive correlation was found between CFR-Doppler and CFR-thermo (y = 0.80 x + 0.10, r = 0.70, p < 0.0001). Stress myocardial perfusion single photon emission computed tomography (SPECT) was performed before coronary angiography in 56 patients (70 vessels), and then fractional flow reserve and CFR-thermo were measured using the dual sensor guide wire. CFR-thermo and fractional flow reserve were significantly lower in coronary segments with positive SPECT image (n = 32) than in coronary segments with negative SPECT image (n = 38) (1.29 +/- 0.24 vs 1.96 +/- 0.69, p < 0.0001; 0.61 +/- 0.13 vs 0.85 +/- 0.09, p < 0.0001). The cut-off values of CFR-thermo and fractional flow reserve for detection of ischemic segments demonstrated by SPECT image were 1.47 and 0.76, respectively. The sensitivity and specificity for detecting ischemia were 78% and 84% for CFR-thermo, 88% and 92% for fractional flow reserve, respectively.


CONCLUSIONS
A significant correlation was found between CFR-thermo measured by the thermodilution principle using the dual sensor guide wire and CFR measured by the Doppler method. CFR-thermo measured by the dual sensor guide wire may be useful to detect myocardial ischemia.
Shindo
Naohisa
N
Second Department of Internal Medicine, Tokyo Medical University, Nishi-Shinjuku 6-7-1, Shinjuku-ku, Tokyo 160-0023.
Tanaka
Nobuhiro
N
Takeda
Kazuhiro
K
Hiraide
Dai
D
Amaya
Kazutaka
K
Kobori
Yuichi
Y
Takazawa
Kenji
K
Yamashina
Akira
A
D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D004301:Doppler Effect; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013815:Thermodilution / Q000295:instrumentation / Q000379:methods*; D015899:Tomography, Emission-Computed, Single-Photon