Article Text

Download PDFPDF

Original research article
Diastolic-systolic velocity ratio to detect coronary stenoses under physiological resting conditions: a mechanistic study
  1. Guus A de Waard1,2,
  2. Christopher J Broyd2,
  3. Christopher M Cook2,
  4. Nina W van der Hoeven1,
  5. Ricardo Petraco2,
  6. Sukhjinder S Nijjer2,
  7. Tim P van de Hoef3,
  8. Mauro Echavarria-Pinto4,5,
  9. Martijn Meuwissen6,
  10. Sayan Sen2,
  11. Paul Knaapen1,
  12. Javier Escaned4,
  13. Jan J Piek3,
  14. Niels van Royen1,7 and
  15. Justin E Davies2
  1. 1 Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
  2. 2 Imperial College London, London, UK
  3. 3 Academic Medical Center, Amsterdam, The Netherlands
  4. 4 Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
  5. 5 Instituto de Seguridad y Servicios Sociales de losTrabajadores del Estado, Mexico City, Mexico
  6. 6 Amphia Hospital, Breda, The Netherlands
  7. 7 Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Dr Guus A de Waard; g.dewaard{at}


Objective Diastolic-systolic velocity ratio (DSVR) is a resting index to assess stenoses in the left anterior descending artery (LAD). DSVR can be measured by echocardiographic or intracoronary Doppler flow velocity. The objective of this cohort study was to elucidate the fundamental rationale underlying the decreased DSVR in coronary stenoses.

Methods In cohort 1, simultaneous measurements of intracoronary Doppler flow velocity and pressure were acquired in the LAD of 228 stable patients. Phasic stenosis resistance, microvascular resistance and total vascular resistance (defined as stenosis and microvascular resistance combined) were studied during physiological resting conditions. Stenoses were classified according to severity by strata of 0.10 fractional flow reserve (FFR) units.

Results DSVR was decreased in stenoses with lower FFR. Stenosis resistance was equal in systole and diastole for every FFR stratum. Microvascular resistance was consistently higher during systole than diastole. In lower FFR strata, stenosis resistance as a percentage of the total vascular resistance increases both during systole and diastole. The difference between the stenosis resistance as a percentage of total vascular resistance during systole and diastole increases for lower FFR strata, with an accompanying rise in diastolic-systolic resistance ratio. A significant inverse correlation was observed between DSVR and the diastolic-systolic resistance ratio (r=0.91, p<0.001). In cohort 2 (n=23), DSVR was measured both invasively and non-invasively by transthoracic echocardiography, yielding a good correlation (r=0.82, p<0.001).

Conclusions The rationale by which DSVR is decreased distal to coronary stenoses is dependent on a comparatively higher influence of the increased stenosis resistance on total vascular resistance during diastole than systole.

  • echocardiography
  • stable angina
  • microvascular

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Contributors GdW, CB, RP, SSN, TPvdH, ME-P, SS, MM, PK, JE, JJP, NvR and JD were involved in data collection. GdW designed the study, performed data and statistical analysis, and drafted the manuscript. NvR and JD supervised the project. All authors made critical revisions to key intellectual content of the manuscript.

  • Funding A fellowship grant awarded to GdW by the ICIN Netherlands Heart Institute helped fund the present study.

  • Competing interests JD is codeveloper of intellectual property, which is licensed to Philips Volcano by Imperial College London. He receives consultancy and research funding from Philips Volcano. CC, RP, SSN, JJP, TPvdH, NVR and JE report receiving fees for speaking at educational events organised by Philips Volcano. The other authors report no conflict of interest.

  • Patient consent for publication Obtained.

  • Ethics approval The different study protocols were approved by the respective institutional review committees and complied with the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.