title: Change in coronary blood flow after percutaneous coronary intervention in relation to baseline lesion physiology: results of the JUSTIFY-PCI study.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) aims to increase coronary blood flow by relieving epicardial obstruction. However, no study has objectively confirmed this and assessed changes in flow over different phases of the cardiac cycle. We quantified the change in resting and hyperemic flow velocity after PCI in stenoses defined physiologically by fractional flow reserve and other parameters.
  
  
  RESULTS
  Seventy-five stenoses (67 patients) underwent paired flow velocity assessment before and after PCI. Flow velocity was measured over the whole cardiac cycle and the wave-free period. Mean fractional flow reserve was 0.68±0.02. Pre-PCI, hyperemic flow velocity is diminished in stenoses classed as physiologically significant compared with those classed nonsignificant (P<0.001). In significant stenoses, flow velocity over the resting wave-free period and hyperemic flow velocity did not differ statistically. After PCI, resting flow velocity over the wave-free period increased little (5.6±1.6 cm/s) and significantly less than hyperemic flow velocity (21.2±3 cm/s; P<0.01). The greatest increase in hyperemic flow velocity was observed when treating stenoses below physiological cut points; treating stenoses with fractional flow reserve ≤0.80 gained Δ28.5±3.8 cm/s, whereas those fractional flow reserve >0.80 had a significantly smaller gain (Δ4.6±2.3 cm/s; P<0.001). The change in pressure-only physiological indices demonstrated a curvilinear relationship to the change in hyperemic flow velocity but was flat for resting flow velocity.
  
  
  CONCLUSIONS
  Pre-PCI physiology is strongly associated with post-PCI increase in hyperemic coronary flow velocity. Hyperemic flow velocity increases 6-fold more when stenoses classed as physiologically significant undergo PCI than when nonsignificant stenoses are treated. Resting flow velocity measured over the wave-free period changes at least 4-fold less than hyperemic flow velocity after PCI.
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Sukhjinder S
authors.initials: SS
authors.lastname: Nijjer
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Ricardo
authors.initials: R
authors.lastname: Petraco
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Tim P
authors.initials: TP
authors.lastname: van de Hoef
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Sayan
authors.initials: S
authors.lastname: Sen
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Martijn A
authors.initials: MA
authors.lastname: van Lavieren
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Foale
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Martijn
authors.initials: M
authors.lastname: Meuwissen
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Broyd
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Mauro
authors.initials: M
authors.lastname: Echavarria-Pinto
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Rasha
authors.initials: R
authors.lastname: Al-Lamee
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Amarjit
authors.initials: A
authors.lastname: Sethi
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Iqbal S
authors.initials: IS
authors.lastname: Malik
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Ghada W
authors.initials: GW
authors.lastname: Mikhail
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Alun D
authors.initials: AD
authors.lastname: Hughes
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Javier
authors.initials: J
authors.lastname: Escaned
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
authors.affiliation: From the National Heart and Lung Institute, Imperial College London, London, United Kingdom (S.S.N., R.P., S.S., R.A.F., C.B., R.A.-L., N.F., A.S., I.S.M., G.W.M., A.D.H., J.M., D.P.F., C.D.M., J.E.D.); AMC Heart Centre, Amsterdam Medical Centre, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular National Institute of Health Research Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.). Justin.Davies@imperial.ac.uk.
authors.forename: Justin E
authors.initials: JE
authors.lastname: Davies
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D055806:Microvessels / Q000502:physiology; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D016896:Treatment Outcome; D014655:Vascular Resistance
keywords: angioplasty; blood flow velocity; percutaneous coronary intervention