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Am J Physiol Heart Circ Physiol 292: H2349-H2355, 2007. First published January 12, 2007; doi:10.1152/ajpheart.01042.2006
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Effect of simultaneous intracoronary guidewires on the predictive accuracy of functional parameters of coronary lesion severity

Hein J. Verberne,1 Martijn Meuwissen,2 Steven A. J. Chamuleau,2 Bart-Jan Verhoeff,2 Berthe L. F. van Eck-Smit,1 Jos A. E. Spaan,3 Jan J. Piek,2 and Maria Siebes2,3

Departments of 1Nuclear Medicine, 2Cardiology, and 3Medical Physics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

Submitted 22 September 2006 ; accepted in final form 9 January 2007

The aim of this study was to assess the influence of a second guidewire on the diagnostic accuracy of functional parameters of coronary lesion severity. Sixty-five patients with intermediate coronary lesions underwent myocardial perfusion scintigraphy. Fractional flow reserve (FFR), coronary flow velocity reserve (CFVR), and hyperemic stenosis resistance (HSR) index (HSR = stenosis pressure gradient ÷ velocity) were determined in 77 lesions. Distal pressure and velocity were acquired simultaneously (dual wire) and sequentially (single wire) with two sensor-equipped guidewires. Overall, functional parameters deteriorated from single- to dual-wire assessment. In patients without ischemia, the good diagnostic performance of FFR, CFVR, and HSR deteriorated significantly (P < 0.001) when assessed by dual wires, with an increase in the number of false-positive results. This trend was more pronounced for HSR, since the presence of a second wire reduced maximal velocity and increased the pressure gradient. The presence of two guidewires, especially across a myocardial perfusion scintigraphy-induced nonsignificant lesion, is associated with overestimation of the hemodynamically assessed lesion severity and, therefore, is likely to have a major impact on clinical decision making. This underscores the advantage of a dual-sensor-equipped guidewire for the evaluation of stenosis severity by combined pressure and velocity measurements.

hemodynamics; microcirculation; pressure; coronary disease; stenosis


Address for reprint requests and other correspondence: H. Verberne, Dept. of Nuclear Medicine, F2-238, Academic Medical Center, Meibergdreef 9, PO Box 22700, 1100 DE Amsterdam, The Netherlands (e-mail: h.j.verberne{at}amc.uva.nl)




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