Comparison of Instantaneous Wave-Free Ratio (iFR) and Fractional Flow Reserve (FFR) with respect to Their Sensitivities to Cardiovascular Factors: A Computational Model-Based Study

Ge, Xinyang; Liu, Youjun; Yin, Zhihua; Tu, Shengxian; Fan, Yuqi; Vassilevski, Yuri; Simakov, Sergey; Liang, Fuyou

doi:10.1155/2020/4094121

Cited by 18 publications

(17 citation statements)

References 51 publications

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“…In one study, discordance group (low FFR despite high iFR) showed significant difference in microvascular resistance, trans stenosis resistance, absolute myocardial blood flow and coronary flow reserve compared to concordant abnormal group [ 39 ]. Ge et al concluded that an increase in coronary microvascular resistance can lead to an increase in both iFR and FFR indices, however the magnitude of FFR increase is greater than that of iFR [ 40 ]. A similar study demonstrated that patients with iFR and FFR discordance had differences in their coronary microvascular resistance during resting and hyperemic states [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Elevated Left Ventricular End Diastolic Pressure on Instantaneous Wave-Free Ratio and Fractional Flow Reserve Discordance

et al. 2021

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Background Instantaneous wave-free ratio (iFR)-guided physiological assessment has been shown to be non-inferior to fractional flow reserve (FFR)-guided assessment for deciding best treatment strategy for angiographically intermediate stenosis. The diagnostic accuracy of iFR compared to FFR reported in various studies is around 80%. Many factors can lead to iFR/FFR discordance, though underlying physiological mechanism of discordance and its associated factors have not been fully evaluated. The effect of left ventricle end diastolic pressure (LVEDP) on iFR/FFR discordance is unknown and needs further evaluation. Methods We performed a single center, non-randomized, both retrospective and prospective study. A total of 65 patients with intermediate coronary stenosis undergoing physiological assessment were included in the study. Patients were assigned to two groups (normal LVEDP and high LVEDP group) based on LVEDP cutoff of 15 mm Hg. iFR and FFR were measured for each patient and iFR/FFR results were compared between the two groups. Results A significantly large number of patients in elevated LVEDP group had iFR/FFR discordance compared to normal LVEDP group (42.8% vs. 6.7%, P = 0.001). More patients with acute coronary syndrome (ACS) had discordance compared to stale coronary artery disease (CAD) patients (53% vs. 15%, P = 0.003). Conclusions Elevated LVEDP can affect iFR and FFR measurements and can lead to discordance. Further studies are required to determine effect of elevated LVEDP on iFR/FFR discordance and whether such discordance is clinically relevant. “Normal range” iFR results should be cautiously interpreted in patients with elevated LVEDP, especially those with ACS.

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Section: Discussionmentioning

confidence: 99%

Effect of Elevated Left Ventricular End Diastolic Pressure on Instantaneous Wave-Free Ratio and Fractional Flow Reserve Discordance

et al. 2021

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“…Next, we investigate sensitivity of haemodynamic indices to heart rate. We adjust stroke volume (12) and systolic duration (11) for each value of heart rate. Exact values are presented in tables A2, A3, A4.…”

Section: Haemodynamic Indices Sensitivity To Heart Ratementioning

confidence: 99%

“…Essential factors for correct clinical interpretation and decision making are the accuracy and sensitivity of the mathematical model to the quality of the input data and diagnostic implications of various coefficients. These aspects were partly studied in [9,[12][13][14][15][16]. E.g.…”

Section: Introductionmentioning

confidence: 99%

Computational Analysis of Haemodynamic Indices in Synthetic Atherosclerotic Coronary Netwroks

Simakov¹,

Gamilov²,

Kopylov³

et al. 2021

Preprint

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Haemodynamic indices are widely used in clinical practice for deciding on a particular type of treatment. Low quality of the CT data and tachycardia complicate interpretation of the measured or simulated values. In this work, we present a novel approach for evaluating resistances in terminal coronary arteries. Using 14 measurements from 10 patients, we show that this algorithm retains the accuracy of 1D haemodynamic simulations in less detailed (truncated) geometric models of coronary networks. We also apply the variable systole fraction model to study the effect of elevated heart rate on the values of FFR, CFR and iFR. We conclude that tachycardia may produce both overestimation or underestimation of coronary stenosis significance.

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“…The computational model was adapted from the models developed in our previous studies where the modeling methods and corresponding numerical schemes have been described in detail [10,14]. In brief, a zero-one-dimensional (0-1-D) multi-scale modeling method was employed to represent the coronary circulation coupled to the global cardiovascular system.…”

Section: Computational Model Of the Coronary Circulationmentioning

confidence: 99%

Impact of Arrhythmia on Myocardial Perfusion: A Computational Model-Based Study

Simakov

Liu

et al. 2021

Mathematics

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(1) Background: Arrhythmia, which is an umbrella term for various types of abnormal rhythms of heartbeat, has a high prevalence in both the general population and patients with coronary artery disease. So far, it remains unclear how different types of arrhythmia would affect myocardial perfusion and the risk/severity of myocardial ischemia. (2) Methods: A computational model of the coronary circulation coupled to the global cardiovascular system was employed to quantify the impacts of arrhythmia and its combination with coronary artery disease on myocardial perfusion. Furthermore, a myocardial supply–demand balance index (MSDBx) was proposed to quantitatively evaluate the severity of myocardial ischemia under various arrhythmic conditions. (3) Results: Tachycardia and severe irregularity of heart rates (HRs) depressed myocardial perfusion and increased the risk of subendocardial ischemia (evaluated by MSDBx), whereas lowering HR improved myocardial perfusion. The presence of a moderate to severe coronary artery stenosis considerably augmented the sensitivity of MSDBx to arrhythmia. Further data analyses revealed that arrhythmia induced myocardial ischemia mainly via reducing the amount of coronary artery blood flow in each individual cardiac cycle rather than increasing the metabolic demand of the myocardium (measured by the left ventricular pressure-volume area). (4) Conclusions: Both tachycardia and irregular heartbeat tend to increase the risk of myocardial ischemia, especially in the subendocardium, and the effects can be further enhanced by concomitant existence of coronary artery disease. In contrast, properly lowering HR using drugs like β-blockers may improve myocardial perfusion, thereby preventing or relieving myocardial ischemia in patients with coronary artery disease.

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Comparison of Instantaneous Wave-Free Ratio (iFR) and Fractional Flow Reserve (FFR) with respect to Their Sensitivities to Cardiovascular Factors: A Computational Model-Based Study

Cited by 18 publications

References 51 publications

Effect of Elevated Left Ventricular End Diastolic Pressure on Instantaneous Wave-Free Ratio and Fractional Flow Reserve Discordance

Effect of Elevated Left Ventricular End Diastolic Pressure on Instantaneous Wave-Free Ratio and Fractional Flow Reserve Discordance

Computational Analysis of Haemodynamic Indices in Synthetic Atherosclerotic Coronary Netwroks

Impact of Arrhythmia on Myocardial Perfusion: A Computational Model-Based Study

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