Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 2:2024:6664482.
doi: 10.1155/2024/6664482. eCollection 2024.

Safety and Feasibility Using a Fluid-Filled Wire to Avoid Hydrostatic Errors in Physiological Intracoronary Measurements

Truls Råmunddal  1   2 , Christian Dworeck  1   2 , Petronella Torild  1 , Sofie Andréen  1 , Li-Ming Gan  1   2 , Geir Hirlekar  1   2 , Dan Ioanes  1 , Anna Myredal  1   2 , Jacob Odenstedt  1   2 , Petur Petursson  1   2 , Tetiana Pylova  2 , Fanny Töpel  1 , Sebastian Völz  1   2 , Mats Hilmersson  3 , Björn Redfors  1   2 , Oskar Angerås  1   2
Affiliations

Safety and Feasibility Using a Fluid-Filled Wire to Avoid Hydrostatic Errors in Physiological Intracoronary Measurements

Truls Råmunddal et al. Cardiol Res Pract. .

Abstract

Background: Using a fluid-filled wire with a pressure sensor outside the patient compared to a conventional pressure wire may avoid the systematic error introduced by the hydrostatic pressure within the coronary circulation.

Aims: To assess the safety and effectiveness of the novel fluid-filled wire, Wirecath (Cavis Technologies, Uppsala, Sweden), as well as its ability to avoid the hydrostatic pressure error.

Methods and results: The Wirecath pressure wire was used in 45 eligible patients who underwent invasive coronary angiography and had a clinical indication for invasive coronary pressure measurement at Sahlgrenska University Hospital, Gothenburg, Sweden. In 29 patients, a simultaneous measurement was performed with a conventional coronary pressure wire (PressureWire X, Abbott Medical, Plymouth, MN, USA), and in 19 patients, the vertical height difference between the tip of the guide catheter and the wire measure point was measured in a 90-degree lateral angiographic projection. No adverse events caused by the pressure wires were reported. The mean Pd/Pa and mean FFR using the fluid-filled wire and the sensor-tipped wire differed significantly; however, after correcting for the hydrostatic effect, the sensor-tipped wire pressure correlated well with the fluid-filled wire pressure (R = 0.74 vs. R = 0.89 at rest and R = 0.89 vs. R = 0.98 at hyperemia).

Conclusion: Hydrostatic errors in physiologic measurements can be avoided by using the fluid-filled Wirecath wire, which was safe to use in the present study. This trial is registered with NCT04776577 and NCT04802681.

PubMed Disclaimer

Conflict of interest statement

Oskar Angerås is a member of the advisory board of Cavis Technologies and a member of the advisory board of Abbott Vascular. He received research grant from Abbott Vascular and speaker fee from Abbott Vascular, Boston Scientific, and Medtronic. Petur Petursson received speaker fee from Medtronic. Sebastian Völz received speaker fee from Abbott Vascular and Boston Scientific. Mats Hilmersson is an employee at Cavis Technologies AB.

Figures

Figure 1
Figure 1
Hydrostatic effects in ∼99% of the population. Illustration of the influence of the height difference between the coronary ostia and distal coronary arteries and the measured pressure.
Figure 2
Figure 2
Wirecath pressure wire with external transducer. Illustration of the design of the fluid-filled wire and transducer.
Figure 3
Figure 3
Enrollment flowchart.
Figure 4
Figure 4
Height measurement between the pressure measure point and the tip of the guide catheter. Example of an observed height difference between the pressure measure point and the tip of the guide catheter.
Figure 5
Figure 5
Correlation between indices derived using the fluid-filled versus sensor-tipped wires. The correlation for both Pd/Pa (a) and fractional flow reserve (FFR) (b) between the two wires was greater when the hydrostatic error due to height was accounted for (right versus left). Passing-Bablok regression indicates that a small proportional bias was present between FFR derived using the fluid-filled wire versus the sensor-tipped wire after correction for hydrostatic pressure (slope 1.14 (95% CI) [1.01–1.38]) but not in the other comparisons.
Figure 6
Figure 6
Correlation between pressure-derived coronary flow reserve (CFR) and CFR derived by echocardiography or thermodilution. (a) Correlation between pressure-derived CFR using the fluid-filled wire and CFR derived by echocardiography (left) and thermodilution (right). (b) Correlation between pressure-derived CFR using the sensor-tipped wire and CFR derived by echocardiography (left) and thermodilution (right).
See this image and copyright information in PMC

References

    1. Knuuti J., Wijns W., Saraste A., et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal . 2020;41(3):407–477. doi: 10.1093/eurheartj/ehz425. - DOI - PubMed
    1. Lawton J. S., Tamis-Holland J. E., Bangalore S., et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: executive summary: a report of the American college of Cardiology/American heart association joint committee on clinical practice guidelines. Circulation . 2022;145(3):e4–e17. doi: 10.1161/cir.0000000000001039. - DOI - PubMed
    1. Lee J. M., Rhee T. M., Choi K. H., et al. Clinical outcome of lesions with discordant results among different invasive physiologic indices ― resting distal coronary to aortic pressure ratio, resting full-cycle ratio, diastolic pressure ratio, instantaneous wave-free ratio, and fractional flow reserve. Circulation Journal . 2019;83(11):2210–2221. doi: 10.1253/circj.cj-19-0230. - DOI - PubMed
    1. Härle T., Luz M., Meyer S., et al. Effect of coronary anatomy and hydrostatic pressure on intracoronary indices of stenosis severity. JACC: Cardiovascular Interventions . 2017;10(8):764–773. doi: 10.1016/j.jcin.2016.12.024. - DOI - PubMed
    1. Al-Janabi F., Karamasis G., Cook C. M., et al. Coronary artery height differences and their effect on fractional flow reserve. Cardiology Journal . 2021;28(1):41–48. doi: 10.5603/cj.a2019.0031. - DOI - PMC - PubMed

Associated data

LinkOut - more resources