The Effect of GRAVITY on Physiological Measurements During Invasive Coronary Angiography and Intervention

Study Overview
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Brief Summary
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This is a single centre observational study on the impact of change in patient position and hence gravity, on physiological measurements in coronary arteries. When patients present with heart attacks involving completely occluded heart arteries, there are signs anecdotally and in literature that arteries sitting higher up with the patient lying flat, receive less blood supply than arteries sitting lower down. The investigators believe this effect is due to the pull of gravity on the flow of blood through the heart arteries. If this is indeed the case, changing position from lying supine (patient on their back) to lying prone (patient on their front) could reverse these anatomical positions and change measurements obtained during a coronary angiogram. These measurements include pressure and flow.

Detailed Description
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The study will contain two groups: Group 1 - stable elective patients with stenotic coronary arteries. These patients are referred as outpatients for a 'pressure wire' test. Group 2 - stable elective patients with a chronic total occlusion of an artery (CTO). The artery will be either the left anterior descending artery (LAD) or right coronary artery (RCA) Group 1 - 30 patients Patients will be recruited from referrals to the centre for a pressure wire study. Participants will be screened for eligibility using the protocol inclusion and exclusion criteria. Study information will be given and informed consent obtained. Patients will start the procedure prone. A physiology wire will be placed in the artery of interest and measurements taken. Patients will then be turned into the standard supine position with repeat measurements. The study is now completed. The usual pressure measurements will be taken and used to guide treatment as per standard protocol. Group 2 - 20 patients Patients will be recruited from referrals to the centre for a percutaneous coronary intervention (PCI) to a chronic total occlusion (CTO). Participants will be screened for eligibility using the protocol inclusion and exclusion criteria. Study information will be given and informed consent obtained. Patients will undergo CTO PCI as per standard procedure. Once completed, the vessel will be occluded using balloon inflation. Physiological measurements will be taken distal to the occluded balloon. The patient will then be turned prone and repeat measurements again with balloon occlusion will be taken. This group will have MRI scanning as part of standard care before the procedure. The study will carry out a further MRI, this time in the prone position before PCI as part of the study protocol

Official Title
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The Effect of GRAVITY on Physiological Measurements During Invasive Coronary Angiography and Intervention

Conditions
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Coronary Artery Disease

Participation Criteria
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Eligibility Criteria
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Group 1 Inclusion Criteria: Age > 18 years of age Angina symptoms or evidence of myocardial ischaemia Stenosis >50% in LAD or RCA on coronary angiogram or CT coronary angiogram Participant is willing and able to give informed consent Eligible for PCI Exclusion Criteria: Previous CABG with any patent grafts Significant left main stem stenosis Lesion of interest in Circumflex artery Haemodynamic Instability Unable to consent Unable to receive dual antiplatelet therapy Contraindication to adenosine Recent acute coronary syndrome (ACS) (<48 hours) Pregnancy Unable to lie prone Severe valvular heart disease or cardiomyopathy Group 2 Inclusion Criteria: Age >18 years of age Stable angina / ischaemic symptoms / and / or Evidence of viability and /or ischaemia in the chronic total occlusion (CTO) territory Participant is willing and able to give informed consent. Presence of chronic total occlusion (CTO) in LAD or RCA Eligible for PCI to a chronic total occlusion (CTO) Exclusion Criteria: Previous CABG with any patent grafts Significant left main stem stenosis Dominant collateral supply from circumflex artery Both LAD and RCA occluded Haemodynamic instability Unable to receive antiplatelet therapy Contraindication to adenosine Recent ACS (<48 hours) eGFR<40 Pregnancy Severe valvular heart disease or cardiomyopathy Contraindication to Cardiac MRI Unable to lie prone

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Group 1<br>Stable elective patients Stenotic coronary artery 10 x LAD 10 x RCA 10 x Cx 30 patients total | |
| Group 2<br>Stable elective patients Chronic total occlusion of one artery 10 x LAD 10 x RCA 20 patients total | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Coronary physiology changes | Changes in coronary physiology in the same vessel when comparing prone and supine patient position | 5 minutes | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| MRI finding | To observe any difference in ischaemia assessment when comparing prone and supine MRI | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Doppler Flow Velocity, Cardiovascular Disease, Atherosclerosis, Hydrostatic Pressure, Percutaneous Coronary Intervention (PCI), Chronic Total Occlusion (CTO), Cardiac MRI, Fractional Flow Reserve (FFR)