title: Coronary pressure notch: an early non-hyperemic visual indicator of the physiologic significance of a coronary artery stenosis.
abstract: The disappearance of a dichrotic notch on the peripheral arterial pulse wave has been associated with significant peripheral vascular disease. A similar observation has not been reported in the distal coronary pressure waveform. The purpose of this study was to investigate the significance of a coronary pressure notch distal to a coronary stenosis and its relationship to fractional flow reserve. Ninety-seven patients with 131 angiographically indeterminate lesions (40-80% diameter narrowing) underwent FFR measurements for physiological significance. Hemodynamic tracings were recorded prior to the administration of adenosine and visually analyzed for the presence or absence of a dicrotic notch in the distal coronary artery pressure tracing. The stenoses were then divided into two groups based on the presence or absence of a notch. Of the 54 lesions without a distal coronary pressure notch, 31 had a FFR greater than or equal to 0.75 and of the 77 lesions with a notch, 75 had a FFR greater than or equal to 0.76. The sensitivity and specificity of a pressure notch was 94% and 74%, respectively, with positive and negative predictive values of 57% and 97%, respectively. The presence of a distal coronary pressure notch was predictive of a FFR greater than or equal to 0.76. The distal dicrotic pressure notch may be used as an additional parameter without requiring hyperemia for FFR measurements of uncertain clinical significance.
authors.affiliation: J.G. Mudd Cardiac Catheterization Lab, St. Louis University Hospital, 3635 Vista Avenue at Grand Blvd., Saint Louis, MO 63110, USA.
authors.forename: David
authors.initials: D
authors.lastname: Holmes
authors.forename: Priya
authors.initials: P
authors.lastname: Velappan
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Kern
mesh_terms: D000367:Age Factors; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006940:Hyperemia / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D011674:Pulse; D012372:ROC Curve; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D014655:Vascular Resistance / Q000502:physiology