Effect of Percutaneous Left Ventricular Unloading on Coronary Flow and Cardiac Coronary Coupling in Patients Undergoing High-Risk Percutaneous Coronary Intervention.
Effect of Percutaneous Left Ventricular Unloading on Coronary Flow and Cardiac Coronary Coupling in Patients Undergoing High-Risk Percutaneous Coronary Intervention.
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经皮左心室减负荷对接受高风险经皮冠状动脉介入治疗的患者冠状动脉血流和心脏冠状动脉耦合的影响。
DOI：
10.1161/circinterventions.120.010454
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Briceno N
中科院分区：
文献类型：
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作者：
Briceno N
经皮冠状动脉介入治疗(PCI)已经发展成为最常用的血管重建方法，但是，尽管取得了进展，一些患者仍然经历了不可接受的围术期并发症和死亡率。经皮左心室辅助装置(PLVAD)越来越多地被用于高危病例的心肌保护，尽管目前有不明确的证据支持这一点。1临床前和临床生理学研究已报道冠状动脉远端压力增加，2同时对急性心肌梗死期间由压力衍生的侧支血流指数产生有利影响3；然而，关于pLVAD对冠状动脉血流的影响的数据很少。因此，我们进行了详细的临床冠状动脉血流动力学研究，以了解机械左心室(LV)卸载对微循环和心脏冠脉偶联的生理影响。我们研究了11名患者(年龄72±9岁)，他们计划在Impella(Abied，Boston)支持下接受高危PCI。术前左室射血分数为26±7%，英国心血管介入学会(BCIS)Jeopardy评分(0~12)为10±3。64%的患者接受了多支血管介入治疗，32%的患者接受了旋转性动脉粥样硬化切除术。在有和没有Impella支持(分别为P8和P1级)和静脉注射腺苷的情况下，使用双压力和多普勒传感器尖端导丝(ComBowire；飞利浦，荷兰)测量冠状动脉远端压力(PD)和流量(作为平均峰值速度[APV])。将压力-容量环导管插入左心室，在有支架和无支架的情况下获得压力-体积环，以计算左心室每搏出功和压力-体积面积。通过对心电波进行波强分析，得出以下指标：冠脉微血管阻力(MR=Pd/APV)、冠脉血流储备(充血时APV/静息时APV)、冠脉灌注效率(加速波能量/总波能)。采用Wilcoxon配对符号列检验比较生理变量(数据为中位数[四分位数范围])。鉴于样本量较小，应谨慎解释P，所述结果仅为假设生成。这项研究得到了英国研究伦理委员会的批准(参考文献12/LO/1793)，所有参与者都表示知情同意。支持这项研究结果的数据可以从相应的作者那里获得，只要提出合理的要求。
Percutaneous coronary intervention (PCI) has evolved to become the most frequently used revascularization modality, but, despite advances, some patients still experience an unacceptable rate of periprocedural complication and mortality. Percutaneous left ventricular assist devices (pLVADs) have increasingly been used to provide myocardial protection in high-risk cases, although there is equivocal evidence to support this at present. 1 Preclinical and clinical physiology studies have reported increases in distal coronary pressure, 2 alongside favorable effects on the pressure-derived collateral flow index during an acute myocardial infarction3; however, there is a paucity of data on the impact of pLVAD on coronary flow. We, therefore, performed a detailed clinical coronary hemodynamic study to understand the physiological effects of mechanical left ventricle (LV) unloading on the microcirculation and cardiac coronary coupling. We studied 11 patients (aged 72±9 years) who were scheduled to undergo high-risk PCI with Impella (Abiomed, Boston) support. Preprocedure LV ejection fraction was 26±7%, and the British Cardiovascular Intervention Society (BCIS)-Jeopardy Score (range, 0–12) was 10±3. Sixty-four percent underwent multivessel PCI, and 32% underwent rotational atherectomy. Following PCI, distal coronary pressure (Pd) and flow (as average peak velocity [APV]) were measured with a dual pressure and Doppler sensor-tipped guidewire (Combowire; Philips, theNetherlands), with and without Impella support (level P8 and P1, respectively) and with autoregulation intact or disabled with intravenous adenosine. A pressure-volume loop catheter was inserted into the LV and pressure-volume loops obtained with and without support for calculation of LV stroke work and pressure-volume area. The following indices were derived: coronary microvascular resistance (MR= Pd/APV), coronary flow reserve (APV at hyperemia/APV at rest), coronary perfusion efficiency (accelerating wave energy/total wave energy), by wave intensity analysis performed on cardiac waves (King’s College London, United Kingdom). A Wilcoxon matched pairs signed-rank test was used to compare physiological variables (data are median [interquartile range]). Given the small sample size, P should be interpreted with caution, and results stated are only hypothesis generating. This study was approved by the UK Research Ethics Committee (reference 12/LO/1793), and all participants gave informed consent. The data that support the findings of this study are available from the corresponding author upon reasonable request.