Coronary pressure notch: an early non-hyperemic visual indicator of the physiologic significance of a coronary artery stenosis.
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.
Holmes
David
D
J.G. Mudd Cardiac Catheterization Lab, St. Louis University Hospital, 3635 Vista Avenue at Grand Blvd., Saint Louis, MO 63110, USA.
Velappan
Priya
P
Kern
Morton J
MJ
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