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@article{Cook:2018:10.1016/j.jacc.2018.06.033,
author = {Cook, CM and Ahmad, Y and Howard, JP and Shun-Shin, MJ and Sethi, A and Clesham, GJ and Tang, KH and Nijjer, SS and Kelly, PA and Davies, JR and Malik, IS and Kaprielian, R and Mikhail, G and Petraco, R and Al-Janabi, F and Karamasis, GV and Mohdnazri, S and Gamma, R and Al-Lamee, R and Keeble, TR and Mayet, J and Sen, S and Francis, DP and Davies, JE},
doi = {10.1016/j.jacc.2018.06.033},
journal = {Journal of the American College of Cardiology},
pages = {970--983},
title = {Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease},
url = {http://dx.doi.org/10.1016/j.jacc.2018.06.033},
volume = {72},
year = {2018}
}
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TY  - JOUR
AB  - 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
AU  - Cook,CM
AU  - Ahmad,Y
AU  - Howard,JP
AU  - Shun-Shin,MJ
AU  - Sethi,A
AU  - Clesham,GJ
AU  - Tang,KH
AU  - Nijjer,SS
AU  - Kelly,PA
AU  - Davies,JR
AU  - Malik,IS
AU  - Kaprielian,R
AU  - Mikhail,G
AU  - Petraco,R
AU  - Al-Janabi,F
AU  - Karamasis,GV
AU  - Mohdnazri,S
AU  - Gamma,R
AU  - Al-Lamee,R
AU  - Keeble,TR
AU  - Mayet,J
AU  - Sen,S
AU  - Francis,DP
AU  - Davies,JE
DO  - 10.1016/j.jacc.2018.06.033
EP  - 983
PY  - 2018///
SN  - 0735-1097
SP  - 970
TI  - Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease
T2  - Journal of the American College of Cardiology
UR  - http://dx.doi.org/10.1016/j.jacc.2018.06.033
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30139442
UR  - http://hdl.handle.net/10044/1/61322
VL  - 72
ER  -
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