Multimodal Epicardial and Endocardial COronary PHYsiological Evaluation in Pathological Situations (PHYCO)

Study Overview
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Brief Summary
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When performing coronary angiography in a stable situation, the identification of an intermediate coronary lesion (between 50 and 70%) is common, and requires additional functional evaluation. The gold standard for this evaluation is Fractional Flow Reserve (FFR). FFR is a flow ratio transformed into a pressure ratio by simplification, neglecting some parameters, especially microcirculatory resistance. The aim of this study is to investigate hemodynamic and structural assessment induced in specific conditions, and their repercussion on functional assessment by FFR to implement the diagnostic approach and personalize it for each patient.

Official Title
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Multimodal Epicardial and Endocardial COronary PHYsiological Evaluation in Pathological Situations

Conditions
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Coronary Artery Disease, Coronary Microvascular Dysfunction

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Intermediate coronary lesion (between 50 and 70%) Exclusion Criteria: Hemodynamic instability Adenosine hypersensitivity Asthma Severe chronic obstructive pulmonary disease Long QTc Wolff parkinson white High degree atriovenricular block Left-right shunt Carotid artery stenosis with hemodynamic insufficiency Pregnancy

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 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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What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Index of Microcirculatory Resistance (IMR) | IMR = Pd x Tmn at maximal hyperhemia Normal range < 25 | During coronary angiography | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fractional Flow Reserve (FFR) | FFR = Pd/Pa at maximal hyperhemia Normal value > 0.80 | During coronary angiography | 
| Coronary Flow Reserve (CFR) | CFR = Hyperhemic flow / Resting flow Normal value > 2 | During coronary angiography | 
| Resting Full cycle Ratio (RFR) | Lowest Pd/Pa value in systole and diastole (mean of 5 consecutive cardiac cycles) Normal value > 0.80 | During coronary angiography | 
| Quantitative Flow Ratio (QFR) | Normal value > 0.80 | During coronary angiography | 
| Angio-IMR | Estimated hyperemic Pa × angio-FFR × [vessel length/(K × Vdiastole)] Normal value < 25 | During coronary angiography | 
| Death |  | 12 months | 
| Angina pectoris (CCS) | Grade I : Angina with strenuous or rapid or prolonged exertion at work or recreation Grade II : Slight limitation of ordinary activity Grade III : Marked limitation of ordinary physical activity Grade IV : Inability to carry on any physical activity without discomfort, anginal syndrome may be present at rest | 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Coronary Artery Disease, Coronary Physiology, Index of Microcirculatory Resistance (IMR)