Beat-to-Beat Coronary Wave Intensity Analysis: Implications of Backward Waves Originating from Microvascular

Xinzhou Xie¹Peng Han²Tiantong Yu³Zixi Huang¹Heqiang Lin¹Songyun Xie¹Bohui Zhang²Shuai Zhao⁴Che Wang⁵Xiang Cheng Li⁶Yan Chen⁷Kun Lian^8*

• ¹Northwestern Polytechnical University, Xi'an, China
• ²Xijing Hospital, Airforce Military Medical University, xian, China
• ³Honghui Hospital, Xi'an, China
• ⁴Air force hospital of western theater command, Chengdu, China
• ⁵School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
• ⁶Xijing Hospital, Fourth Military Medical, xian, China
• ⁷PLA Navy Submarine Academy, Qingdao, China
• ⁸Department of cardiology, Xijing hostipital, The Fourth Military Medical University, Xi'an, China

While coronary wave intensity analysis (cWIA) offers a promising way to assess myocardial and microvascular function by decomposing microvascular-originated backward waves, its clinical utility is currently limited by complex data acquisition and unclear influence of varying hemodynamic factors (adenosine, stenosis and vessel type). This study introduces an angiography-based cWIA method and clarifies how those hemodynamic factors impact cWIA parameters. This retrospective study included 124 patients with 125 target vessels, for which beat-to-beat cWIA was successfully performed at rest and during adenosine-induced hyperemia. Our analysis revealed a strong and significant correlation between cumulative backward compression wave intensity (cBCW) and cumulative backward decompression wave intensity (cBDW) in both resting (rho=0.846, 95%CI: 0.786 to 0.891, p<0.001) and hyperemic states (rho=0.768, 95%CI: 0.681 to 0.833, p<0.001). Compared to rest, adenosine-induced hyperemia significantly increased cBCW (1.88±1.46 ×104 W/m2s vs. 2.31±1.74×104 W/m2s, p<0.001) and peak backward compression wave intensity (pBCW) (4.30±4.61 ×105 W/m2s2 vs. 5.21±4.68×105 W/m2s2, p=0.008), while significantly decreasing peak backward decompression wave intensity (pBDW) (5.41± 6.06 ×105 W/m2s2 vs. 3.99±4.64×105 W/m2s2, p<0.001), with no significant effect on cBDW. Neither functional stenotic lesions nor vessel type (left anterior descending coronary artery (LAD) or right coronary artery (RCA)) significantly impacted quantitative parameters of the microvascular-originated backward waves. The clinical feasibility of a convenient cWIA method was validated, and the impact of various hemodynamic factors on quantitative parameters of cWIA were analyzed, providing strong support for the clinical application of cWIA.