Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease

Cook, Christopher M. and Ahmad, Yousif and Howard, James P. and Shun-Shin, Matthew J. and Sethi, Amarjit and Clesham, Gerald J. and Tang, Kare H. and Nijjer, Sukhjinder S. and Kelly, Paul A. and Davies, John R. and Malik, Iqbal S. and Kaprielian, Raffi and Petraco, Ricardo and Mikhail, Ghada and Petraco, Ricardo and Al-Janabi, Firas and Karamasis, Grigoris V. and Mohdnazri, Shah H. and Gamma, Reto and Al-Lamee, Rasha and Keeble, Thomas R. and Mayet, Jamil and Sen, Sayan and Francis, Darrel P. and Davies, Justin E. (2018) Impact of Percutaneous Revascularization on Exercise Hemodynamics in Patients With Stable Coronary Disease. Journal of the American College of Cardiology, 72 (9). pp. 970-983. ISSN 1558-3597

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Official URL: https://doi.org/10.1016/j.jacc.2018.06.033

Abstract

Background: Recently, the therapeutic benefits of percutaneous coronary intervention (PCI) have been challenged in patients with stable coronary artery disease (SCD). Objectives: The authors examined the impact of PCI on exercise responses in the coronary circulation, the microcirculation, and systemic hemodynamics in patients with SCD. Methods: A total of 21 patients (mean age 60.3 ± 8.4 years) with SCD and single-vessel coronary stenosis underwent cardiac catheterization. Pre-PCI, patients exercised on a supine ergometer until rate-limiting angina or exhaustion. Simultaneous trans-stenotic coronary pressure-flow measurements were made throughout exercise. Post-PCI, this process was repeated. Physiological parameters, rate-limiting symptoms, and exercise performance were compared between pre-PCI and post-PCI exercise cycles. Results: PCI reduced ischemia as documented by fractional flow reserve value (pre-PCI 0.59 ± 0.18 to post-PCI 0.91 ± 0.07), instantaneous wave-free ratio value (pre-PCI 0.61 ± 0.27 to post-PCI 0.96 ± 0.05) and coronary flow reserve value (pre-PCI 1.7 ± 0.7 to post-PCI 3.1 ± 1.0; p < 0.001 for all). PCI increased peak-exercise average peak coronary flow velocity (p < 0.0001), coronary perfusion pressure (distal coronary pressure; p < 0.0001), systolic blood pressure (p = 0.01), accelerating wave energy (p < 0.001), and myocardial workload (rate-pressure product; p < 0.01). These changes observed immediately following PCI resulted from the abolition of stenosis resistance (p < 0.0001). PCI was also associated with an immediate improvement in exercise time (+67 s; 95% confidence interval: 31 to 102 s; p < 0.0001) and a reduction in rate-limiting angina symptoms (81% reduction in rate-limiting angina symptoms post-PCI; p < 0.001). Conclusions: In patients with SCD and severe single-vessel stenosis, objective physiological responses to exercise immediately normalize following PCI. This is seen in the coronary circulation, the microcirculation, and systemic hemodynamics.

Item Type: Journal Article
Keywords: coronary physiology, exercise, percutaneous coronary intervention, stable coronary disease
Faculty: ARCHIVED Faculty of Medical Science (until September 2018)
Depositing User: Ian Walker
Date Deposited: 18 Jun 2018 10:39
Last Modified: 14 Nov 2019 16:09
URI: http://arro.anglia.ac.uk/id/eprint/703146

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