TCT-524 Invasive minimal Microvascular Resistance (mMR); a new index to assess microcirculatory dysfunction that is not modulated by the presence of angiographic coronary artery disease

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016

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BACKGROUND Instantaneous hyperemic diastolic velocity pressure slope (IHDVPS) is a measure of coronary conductance. IHDVPS is defined as the slope of the relationship between intracoronary hyperaemic pressure and Doppler flow velocity flow in mid to end diastole. In the presence of coronary artery disease, IHDVPS can be either calculated using the aortic pressure (IHDVPSPa) or distal coronary pressure (IHDVPSPd). METHODS In 335 patients scheduled for CAG, intracoronary measurements were performed using a combined pressure and Doppler flow velocity wire. Using a customized, automated algorithm (written in R project software) the diastolic period was recognized using the peak flow velocity and the sharp decrease in flow velocity at the end of diastole. The slope of the pressure-flow regression line represents IHDVPS (cm/s-1/mmHg-1). RESULTS IHDVPSPa and IHDVPSPd were calculated in 78% of the initial 567 vessels. There were 245 stenotic vessels and 207 reference vessels (83 with a positive FFR and 369 were FFR negative). Mean IHDVPSPa was 1.09
0.53 and IHDVPSPd was 1.41
0.66. IHDVPSPd was independent of all parameters indicating epicardial stenosis. After multiple regression analysis, IHDVPSPd was significantly associated with age (b-0.012, SE0.003, p¼0.000) and previous MI (b0.316, SE0.121, p¼0.009). IHDVPSPa was associated with age (b-0.009, SE0.004, p¼0.016) and diameter stenosis % (b-0.008, p¼0.000). CONCLUSION A comprehensive assessment of the coronary circulation is feasible using IHDVPS. IHDVPSPd is independent of epicardial stenosis, compared to IHDVPSPa. IHDVPSPd is associated with age and previous MI. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment

TCT-524 Invasive minimal Microvascular Resistance (mMR); a new index to assess microcirculatory dysfunction that is not modulated by the presence of angiographic coronary artery disease

CONCLUSION Coronary MVD starts as a focal phenomenon and spreads globally with unpredictable manner. Epicardial coronary disease severity is not predictive of regional or global MVD, suggesting the importance of measuring IMR to detect MVD. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-523 Instantaneous Hyperemic Diastolic Velocity Pressure Slope for comprehensive physiological evaluation of epicardial and microvascular status Nina van der Hoeven,1 Alicia Quirós,2 Guus de Waard,3 Christopher Broyd,4 Sukhjinder Nijjer,5 Tim van de Hoef,6 Ricardo Petraco,7 Roel Driessen,8 Hernán Mejía-Rentería,9 Martijn van Lavieren,10 Martijn Meuwissen,11 Ibrahim Danad,12 Paul Knaapen,13 Jan Piek,14 Justin Davies,15 Niels van Royen,16 Javier Escaned17 1 Columbia University Medical Center, Amsterdam, Netherlands; 2The Heart Hospital Baylor Plano; 3VUMC, Amsterdam, Netherlands; 4 Imperial College, London, United Kingdom; 5Imperial College London, London, United Kingdom; 6Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands; 7Imperial College, London, United Kingdom; 8Baylor Heart and Vascular Hospital, Dallas, Texas; 9 Loyola Stritch School of Medicine; 10Academic Medical CenterUniversity of Amster, Amsterdam, Netherlands; 11Breda Amphia Ziekenhuis, Breda, Netherlands; 12Meenakshi Mission Hospital and Research Centre; 13VU University Medical Center, Amsterdam, Netherlands; 14University of Amsterdam, Amsterdam, Netherlands; 15 Imperial College London NHS Trust, London, United Kingdom; 16 VUmc Amsterdam, Amsterdam, Netherlands; 17Hospital Clínico San Carlos, Madrid, Spain

Guus de Waard,1 Sukhjinder Nijjer,2 Martijn van Lavieren,3 Nina van der Hoeven,4 Ricardo Petraco,5 Tim van de Hoef,6 Mauro Echavarria Pinto,7 Sayan Sen,8 Peter van de Ven,9 Paul Knaapen,10 Javier Escaned,11 Jan Piek,12 Justin Davies,13 Niels van Royen14 1 VU Medical Center, Amsterdam, The Netherlands; 2Imperial College London, London, United Kingdom; 3Academic Medical CenterUniversity of Amster, Amsterdam, Netherlands; 4Columbia University Medical Center, Amsterdam, Netherlands; 5Imperial College, London, United Kingdom; 6Academic Medical Center - University of Amsterdam, Amsterdam, Netherlands; 7Hospital General ISSSTE, Queretaro, Querétaro, Mexico; 8National Heart & Lung Institute, London, United Kingdom; 9National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy; 10VU University Medical Center, Amsterdam, Netherlands; 11 Hospital Clínico San Carlos, Madrid, Spain; 12University of Amsterdam, Amsterdam, Netherlands; 13Imperial College London NHS Trust, London, United Kingdom; 14VUmc Amsterdam, Amsterdam, Netherlands BACKGROUND Coronary microcirculatory dysfunction (MCD) portends a worse cardiovascular outcome. Invasive assessment of MCD by coronary flow reserve (CFR) and hyperemic microvascular resistance (HMR) is affected by the presence of coronary artery disease (CAD). Here, we introduce the minimal microvascular resistance (mMR) as a new measure of MCD and investigate whether mMR is influenced by CAD. METHODS 482 simultaneous measurements of Doppler flow velocity and distal pressure in coronary arteries were obtained in 301 patients. mMR is measured during the hyperemic wave-free period specifically and defined as the ratio between distal coronary pressure and flow velocity during this period (see Figure). Measurements were divided into two cohorts. Cohort 1 was a paired analysis involving 82 pairs with both a vessel with and a vessel without CAD. Cohort 2 involved the remaining 341 measurements and was used to validate the findings of Cohort 1. In Cohort 2, the interaction between diameter stenosis % and risk factors for cardiovascular disease with CFR, HMR and mMR was investigated.

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016

CONCLUSION FFR was a well-tolerated, valid and reproducible tool during PI for TRAS. It’s use in moderate or equivocal lesions, evaluation of PI results and specially in association with clinical response to treatment should be further explored. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-526 The Index of Microvascular Resistance Predicts Immediate Recovery of Left Ventricular Systolic Function Following PCI in Patients with NSTEACS Kevin Liou,1 Nigel Jepson,2 Virag Kushwaha,3 Jenny Yu,4 Greg Cranney,5 Sze-Yuan Ooi6 1 Prince of Wales Hospital, Sydney, New South Wales, Australia; 2Prince of Wales Hospital, Sydney, New South Wales, Australia; 3Hyogo Prefectural Awaji Medical Center; 4Odense University Hospital; 5Aurora Sinai/Aurora St. Luke’s Medical Centers; 6Prince of Wales Hospital, Sydney, New South Wales, Australia RESULTS In Cohort 1, CFR was significantly lower (2.12
0.79 vs. 2.56
0.63; p<0.001) and HMR was significantly higher (2.61
1.22 vs. 2.31
0.89; p¼0.04) in vessels with CAD than the vessels without CAD, within the same patient. mMR was equivalent in obstructed and nonobstructed vessels: 1.54
0.77 vs. 1.53
0.57; p¼0.90. Cohort 2 confirmed these findings, showing a significant relationship for CFR and HMR with diameter stenosis % (b¼-0.013, 95%CI [-0.016 to -0.010]; p<0.001 for CFR and b¼0.008, 95%CI [0.004 to 0.011]; p<0.001 for HMR per 1%), while mMR was independent of diameter stenosis % (b¼0.002, 95%CI [-0.001 to 0.004] per 1%; p¼0.15). No association was found between mMR and any of the risk factors for cardiovascular disease. CONCLUSION Minimal microvascular resistance is a novel index to assess MCD. mMR possesses the unique property that it does not depend on the presence of CAD, unlike CFR and HMR which are currently used to assess MCD. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment

TCT-525 Initial experience with the use of fractional flow reserve in percutaneous intervention of transplant renal artery stenosis Manuel Pereira Marques Gomes Junior,1 Claudia Alves,2 Adriano Barbosa,3 Jose Souza,4 Marco Tulio Souza,5 Cristiano Souza,6 Ricardo Peressoni Faraco,7 marcelo batista,8 José Osmar Pestana,9 Antonio Carlos Carvalho10 1 Hospital do Coração, São Paulo, São Paulo, Brazil; 2Paulista School of Medicine, São Paulo, São Paulo, Brazil; 3Hospital São Paulo, São Paulo, São Paulo, Brazil; 4Unknown; 5Unifesp, São Paulo, São Paulo, Brazil; 6 Unknown; 7Unknown; 8Unifesp; 9Corporate Technology, Siemens SRL; 10 KCRI BACKGROUND Renal transplantation is the standard treatment for patients with end-stage kidney disease, reducing morbidity and mortality of patients in this condition. Transplant renal artery stenosis (TRAS) is the leading cause of early graft dysfunction and hypertension. Percutaneous intervention (PI) is the method of choice for the treatment of TRAS with satisfactory results and few short-term complications. To date there is no data in the literature on the use of fractional flow reserve (FFR) to access functional significance of TRAS in questionable lesions and to guide PI. Our goal was a feasibility and standardization study in an initial series of patients with unquestionable stenosis, performing fractional flow reserve pre and post PT. METHODS Patients with TRAS detected in a non-invasive study were referred to diagnostic angiography with intention to treat and only TRAS stenosis considered visually severe ( 60%) were included. After selective cannulation of the transplanted renal artery, a Pressure Wire 0.014 (CertusÔ St. Jude Medical) was advanced to the distal portion of the vessel and maximum hyperemia was obtained with 30 mg of Papaverine. FFR was registered pre and post intervention. Statistical analyses were carried out in SPSS software (22.0) at a 2sided alpha level of 0.05. RESULTS Between 2012and2014, 10 patients were included, Graft dysfunction was present in 90% and resistant hypertension in 100%. Average time of transplantation was 11
7 months. All procedures were successfull. FFR pre procedure was 0.757
0.14, and post PI 0.99
0.08 (p<0,05). All patients had FFR values below 0.9 before treatment and above this limit after treatment. No complications occurred during papaverine infusion or the procedure.

BACKGROUND Coronary microvascular dysfunction has been shown to prognosticate patients with STEMI following primary PCI. Its role in patients with NSTEACS however has not been thoroughly investigated. This study aims to evaluate the relationship between Index of Microvascular Resistance (IMR) and acute recovery of left ventricular systolic function in patients undergoing PCI for NSTEACS, as measured with Global Longitudinal Strain (GLS) on 2D echocardiography by speckle tracking methodology. METHODS Echocardiograms were performed immediately before and within 24 hours after PCI. Serial GLS were recorded. Coronary physiological measurements were made immediately before and after PCI with the St. Jude CertusTM PressureWireTM (St. Paul, Minnesota, USA) with maximal hyperaemia, and IMR derived using Pa x Tmn x (Pd-Pw)/(Pa-Pw). RESULTS 50 patients undergoing PCI for NSTEACS were included for analysis. Overall, 82% were males and the mean age was 65. 52% had hypertension and the mean BMI was 29.2. 78% of the patients presented with NSTEMI, while the rest had UAP. The overall mean pre and post-procedural IMR, GLS, and fractional flow reserve (FFR) were 25.9, 24.7, -16.6%, -16.3%, 0.61 and 0.91, respectively. The median relative peri-procedural change in IMR was -12.0% (IQR: -92.3-68.3%). There was a significant association between peri-procedural change in IMR and GLS (DIMR vs. DGLS, r¼-0.42, p¼0.004), and between post-procedural IMR and DGLS (r¼0.31, p¼0.031). For every 50% peri-procedural increase in IMR, there was a corresponding 1.2% absolute decline in GLS. The mean absolute post-procedural decline in GLS was 1.8% if the post procedural IMR was 30 (vs. -0.2%, p¼0.024). There was no significant correlation between pre-procedural IMR and DGLS, nor between peri-procedural change in FFR and DGLS. CONCLUSION Our data suggests that peri-procedural change in, and the post-procedural state of coronary microcirculation correlates with acute recovery in left ventricular longitudinal function as measured with GLS in patients undergoing PCI for NSTEACS. Pre-procedural IMR and restoration of FFR however did not have any significant impact on immediate LV recovery. CATEGORIES IMAGING: FFR and Physiologic Lesion Assessment TCT-527 A data-driven approach combining image-based anatomical features and resting state measurements for the functional assessment of coronary artery disease Lucian Calmac,1 Rodica Niculescu,2 Elisabeta Badila,3 Emma Weiss,4 Daniela Penes,5 Diana Zamfir,6 Lucian Itu,7 Laszlo Lazar,8 Marius Carp,9 Alexandru Itu,10 Constantin Suciu,11 Tiziano Passerini,12 Puneet Sharma,13 Bogdan Georgescu,14 Dorin Comaniciu15 1 Spitalul Clinic de Urgenta Buc, Bucuresti, Romania; 2Sanador Hospital, bucharest, Romania; 3Emergency Clinical Hospital of Bucharest, Bucharest, Romania; 4Regional Emergency Center; 5Minneapolis Heart Institute; 6Hull and East Yorkshire Hospitals NHS Trust; 7Siemens SRL, Brasov, Romania; 8The University of Tokyo Hospital; 9Henry Ford Health System; 10The University of Tokyo Hospital; 11National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy; 12Washington University; 13Siemens, Princeton, New Jersey, United States; 14Unknown, Princeton, New Jersey, United States; 15National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy