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Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease

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Title: Impact of percutaneous revascularization on exercise hemodynamics in patients with stable coronary disease
Authors: Cook, CM
Ahmad, Y
James, H
Shun-Shin, M
Sethi, A
Clesham, G
Tang, K
Nijjer, S
Kelly, P
Davies, J
Malik, I
Kaprielian, R
Mikhail, G
Petraco, R
Al-Janabi, F
Karamasis, G
Mohdnazri, S
Gamma, R
Al-Lamee, R
Keeble, T
Mayet, J
Sen, S
Francis, D
Davies, J
Item Type: Journal Article
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.
Issue Date: 28-Aug-2018
Date of Acceptance: 9-Jun-2018
URI: http://hdl.handle.net/10044/1/61322
DOI: https://dx.doi.org/10.1016/j.jacc.2018.06.033
ISSN: 0735-1097
Publisher: Elsevier
Start Page: 970
End Page: 983
Journal / Book Title: Journal of the American College of Cardiology
Volume: 72
Issue: 9
Copyright Statement: © 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article underthe CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Sponsor/Funder: Medical Research Council (MRC)
British Heart Foundation
Funder's Grant Number: MR/M018369/1
FS/14/27/30752
Keywords: Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
1117 Public Health and Health Services
Publication Status: Published
Online Publication Date: 2018-08-20
Appears in Collections:National Heart and Lung Institute