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Functional assessment of myocardial ischaemia by intracoronary ECG
INTRODUCTION: In patients with chronic coronary syndrome, percutaneous coronary intervention targets haemodynamically significant stenoses, that is, those thought to cause ischaemia. Intracoronary ECG (icECG) detects ischaemia directly where it occurs. Thus, the goal of this study was to test the ac...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816923/ https://www.ncbi.nlm.nih.gov/pubmed/33462106 http://dx.doi.org/10.1136/openhrt-2020-001447 |
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author | Bigler, Marius Reto Stoller, Michael Praz, Fabien Siontis, George C M Grossenbacher, Raphael Tschannen, Christine Seiler, Christian |
author_facet | Bigler, Marius Reto Stoller, Michael Praz, Fabien Siontis, George C M Grossenbacher, Raphael Tschannen, Christine Seiler, Christian |
author_sort | Bigler, Marius Reto |
collection | PubMed |
description | INTRODUCTION: In patients with chronic coronary syndrome, percutaneous coronary intervention targets haemodynamically significant stenoses, that is, those thought to cause ischaemia. Intracoronary ECG (icECG) detects ischaemia directly where it occurs. Thus, the goal of this study was to test the accuracy of icECG during pharmacological inotropic stress to determine functional coronary lesion severity in comparison to the structural parameter of quantitative angiographic per cent diameter stenosis (%S), as well as to the haemodynamic indices of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). METHOD: The primary study endpoint of this prospective trial was the maximal change in icECG ST-segment shift during pharmacological inotropic stress induced by dobutamine plus atropine obtained within 1 min after reaching maximal heart rate(=220 - age). IcECG was acquired by attaching an alligator clamp to the angioplasty guidewire positioned downstream of the stenosis. For the pressure-derived stenosis severity ratios, coronary perfusion pressure and simultaneous aortic pressure were continuously recorded. RESULTS: There was a direct linear relation between icECG ST-segment shift and %S: icECG=−0.8+0.03*%S (r(2)=0.164; p<0.0001). There were inverse linear correlations between FFR and %S: FFR=1.1–6.1*10–3*%S (r(2)=0.494; p<0.0001), and between iFR and %S: iFR=1.27–8.6*10–3*%S (r(2)=0.461; p<0.0001). Using a %S-threshold of ≥50% as the reference for structural stenosis relevance, receiver operating characteristics-analysis of absolute icECG ST-segment shift during hyperemia showed an area under the curve (AUC) of 0.678±0.054 (p=0.002; sensitivity=85%, specificity=50% at 0.34 mV). AUC for FFR was 0.854±0.037 (p<0.0001; sensitivity=64%, specificity=96% at 0.78), and for iFR it was 0.816±0.043 (p<0.0001;sensitivity=62%, specificity=96% at 0.83). CONCLUSIONS: Hyperaemic icECG ST-segment shift detects structurally relevant coronary stenotic lesions with high sensitivity, while they are identified highly specific by FFR and iFR. |
format | Online Article Text |
id | pubmed-7816923 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-78169232021-01-28 Functional assessment of myocardial ischaemia by intracoronary ECG Bigler, Marius Reto Stoller, Michael Praz, Fabien Siontis, George C M Grossenbacher, Raphael Tschannen, Christine Seiler, Christian Open Heart Coronary Artery Disease INTRODUCTION: In patients with chronic coronary syndrome, percutaneous coronary intervention targets haemodynamically significant stenoses, that is, those thought to cause ischaemia. Intracoronary ECG (icECG) detects ischaemia directly where it occurs. Thus, the goal of this study was to test the accuracy of icECG during pharmacological inotropic stress to determine functional coronary lesion severity in comparison to the structural parameter of quantitative angiographic per cent diameter stenosis (%S), as well as to the haemodynamic indices of fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR). METHOD: The primary study endpoint of this prospective trial was the maximal change in icECG ST-segment shift during pharmacological inotropic stress induced by dobutamine plus atropine obtained within 1 min after reaching maximal heart rate(=220 - age). IcECG was acquired by attaching an alligator clamp to the angioplasty guidewire positioned downstream of the stenosis. For the pressure-derived stenosis severity ratios, coronary perfusion pressure and simultaneous aortic pressure were continuously recorded. RESULTS: There was a direct linear relation between icECG ST-segment shift and %S: icECG=−0.8+0.03*%S (r(2)=0.164; p<0.0001). There were inverse linear correlations between FFR and %S: FFR=1.1–6.1*10–3*%S (r(2)=0.494; p<0.0001), and between iFR and %S: iFR=1.27–8.6*10–3*%S (r(2)=0.461; p<0.0001). Using a %S-threshold of ≥50% as the reference for structural stenosis relevance, receiver operating characteristics-analysis of absolute icECG ST-segment shift during hyperemia showed an area under the curve (AUC) of 0.678±0.054 (p=0.002; sensitivity=85%, specificity=50% at 0.34 mV). AUC for FFR was 0.854±0.037 (p<0.0001; sensitivity=64%, specificity=96% at 0.78), and for iFR it was 0.816±0.043 (p<0.0001;sensitivity=62%, specificity=96% at 0.83). CONCLUSIONS: Hyperaemic icECG ST-segment shift detects structurally relevant coronary stenotic lesions with high sensitivity, while they are identified highly specific by FFR and iFR. BMJ Publishing Group 2021-01-18 /pmc/articles/PMC7816923/ /pubmed/33462106 http://dx.doi.org/10.1136/openhrt-2020-001447 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Coronary Artery Disease Bigler, Marius Reto Stoller, Michael Praz, Fabien Siontis, George C M Grossenbacher, Raphael Tschannen, Christine Seiler, Christian Functional assessment of myocardial ischaemia by intracoronary ECG |
title | Functional assessment of myocardial ischaemia by intracoronary ECG |
title_full | Functional assessment of myocardial ischaemia by intracoronary ECG |
title_fullStr | Functional assessment of myocardial ischaemia by intracoronary ECG |
title_full_unstemmed | Functional assessment of myocardial ischaemia by intracoronary ECG |
title_short | Functional assessment of myocardial ischaemia by intracoronary ECG |
title_sort | functional assessment of myocardial ischaemia by intracoronary ecg |
topic | Coronary Artery Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816923/ https://www.ncbi.nlm.nih.gov/pubmed/33462106 http://dx.doi.org/10.1136/openhrt-2020-001447 |
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