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 (2021). Functional assessment of myocardial ischaemia by intracoronary ECG. Open Heart, 8(1) B M J Group 10.1136/openhrt-2020-001447

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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 (r2=0.164; p<0.0001). There were inverse linear correlations between FFR and %S: FFR=1.1-6.1*10-3*%S (r2=0.494; p<0.0001), and between iFR and %S: iFR=1.27-8.6*10-3*%S (r2=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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

Graduate School:

Graduate School for Cellular and Biomedical Sciences (GCB)

UniBE Contributor:

Bigler, Marius Reto and Praz, Fabien Daniel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2053-3624

Publisher:

B M J Group

Language:

English

Submitter:

Andrea Stettler

Date Deposited:

20 Jan 2021 15:45

Last Modified:

17 Mar 2021 05:19

Publisher DOI:

10.1136/openhrt-2020-001447

PubMed ID:

33462106

Uncontrolled Keywords:

cardiac catheterisation coronary angiography coronary stenosis electrocardiography percutaneous coronary intervention

BORIS DOI:

10.48350/151420

URI:

https://boris.unibe.ch/id/eprint/151420

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