Fractional Flow Reserve

Pijls, Nico H.J.; Van Gelder, Berry; Van der Voort, Pepijn; Peels, Kathinka; Bracke, Frank A.L.E.; Bonnier, Hans J.R.M.; El Gamal, Mamdouh I.H.

doi:10.1161/01.cir.92.11.3183

Cited by 705 publications

(101 citation statements)

References 48 publications

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“…The flow patterns such as velocity directions strongly influenced by the geometry of the stenosis formed and it is more complex to assess the physiological severity of an intermediate stenosis in a single vessel or branched vessel using usual coronary angiogram or multislice computed tomography [2, 3]. The true functional severity of coronary artery stenosis is assessed by pressure drop and flow [4–6]. …”

Section: Introductionmentioning

confidence: 99%

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Numerical Investigation of the Effect of Stenosis Geometry on the Coronary Diagnostic Parameters

Kamangar

Govindaraju

Badruddin

et al. 2014

The Scientific World Journal

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The present study deals with the functional severity of a coronary artery stenosis assessed by the fractional flow reserve (FFR). The effects of different geometrical shapes of lesion on the diagnostic parameters are unknown. In this study, 3D computational simulation of blood flow in three different geometrical shapes of stenosis (triangular, elliptical, and trapezium) is considered in steady and transient conditions for 70% (moderate), 80% (intermediate), and 90% (severe) area stenosis (AS). For a given percentage AS, the variation of diagnostic parameters which are derived from pressure drop across the stenosis was found in three different geometrical shapes of stenosis and it was observed that FFR is higher in triangular shape and lower in trapezium shape. The pressure drop coefficient (CDP) was higher in trapezium shape and lower in triangular model whereas the LFC shows opposite trend. From the clinical perspective, the relationship between percentage AS and FFR is linear and inversely related in all the three models. A cut-off value of 0.75 for FFR was observed at 76.5% AS in trapezium model, 79.5% in elliptical model, and 82.7% AS for the triangular shaped model. The misinterpretation of the functional severity of the stenosis is in the region of 76.5%-82.7 % AS from different shapes of stenosis models.

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Section: Introductionmentioning

confidence: 99%

“…Many of the clinical studies show that a FFR value of ≤0.75 identifies ischemia-causing coronary stenosis with an accuracy of 90% [6]. …”

Section: Introductionmentioning

confidence: 99%

Numerical Investigation of the Effect of Stenosis Geometry on the Coronary Diagnostic Parameters

Kamangar

Govindaraju

Badruddin

et al. 2014

The Scientific World Journal

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“…Moreover, it is possible that alternate methods to normalize Doppler velocity reserve are perhaps more appropriate in a clinical setting such as relative velocity reserve defined as the ratio of Doppler velocity reserve in a stenosed and a patent artery [31]. Also, fractional flow reserve calculated from intracoronary pressure measurements obtained during vasodilation has been demonstrated to be both an accurate method to detect flow-limiting stenoses [32, 33, 34, 35]and a valuable clinical tool to identify patients at low risk for future coronary events [36]. In particular, fractional flow reserve has been reported to be superior to intracoronary Doppler measurements as it is easier to perform in clinical routine and likely is less sensitive to hemodynamic conditions.…”

Section: Discussionmentioning

confidence: 99%

Functional Assessment of Coronary Arteries by Poststenotic Intravascular Doppler Ultrasound

Porenta

Binder²,

Moertl³

et al. 2000

J Vasc Res

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This study sought to delineate the impact of the rate pressure product on intraluminal Doppler velocity measurements and to determine the relation between poststenotic vasodilator reserve and percent luminal obstruction in coronary vessels. Twenty patients with single-vessel coronary disease were studied prior to coronary angioplasty and at follow-up 6 months later. Intracoronary velocity reserve after administration of adenosine was measured distal to the stenosis with a Doppler-tipped guide wire and was compared to quantitative coronary angiography and adenosine myocardial perfusion scintigraphy. The rate pressure product was confirmed as significant covariate (ANCOVA, p < 0.005) of intracoronary Doppler reserve. When normalized to rate pressure product, poststenotic Doppler velocity reserve in stenosed arteries was significantly lower than in patent arteries as classified by quantitative coronary angiography (1.7 ± 0.6 vs. 2.9 ± 0.5, p < 0.001) and perfusion scintigraphy (1.5 ± 0.4 vs. 2.8 ± 0.5, p < 0.001). Normalized Doppler velocity reserve showed a nonlinear but highly significant relation to percent area stenosis [y = 3.0·(1 – exp[0.081 (x – 100)]), p < 0.001]. When normalized Doppler velocity reserve was less than 2.0, coronary disease was identified with 95% specificity and 94% sensitivity in comparison to perfusion scintigraphy. Thus, in coronary arteries poststenotic Doppler reserve and percent area stenosis show a significant nonlinear relation. Doppler velocity reserve when normalized to rate pressure product can be used to characterize the hemodynamic impact of coronary obstructions.

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“…FFR is the most widely used functional parameter and is considered by many to be the gold standard for the evaluation of functional significance of coronary stenosis [7][8][9]. Under a clinical setting, FFR is invasively measured with a pressure wire at maximal arterial vasodilation (hyperemia) induced using a vasodilatory drug.…”

Section: Introductionmentioning

confidence: 99%

“…Under a clinical setting, FFR is invasively measured with a pressure wire at maximal arterial vasodilation (hyperemia) induced using a vasodilatory drug. Previous clinical studies have reported an FFR cut-off of 0.75 for a stenosis present in a single vessel [4,7,10] and 0.80 for stenoses present in multiple vessels [11][12][13]. Cases with an FFR below 0.75 are recommended for further clinical intervention while those with a value above 0.80 are deferred further intervention.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Uncertainties During Assessment of Serial Coronary Stenoses: An In Vitro Study

D’Souza

Peelukhana

Banerjee

2014

Journal of Biomechanical Engineering

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Currently, the diagnosis of coronary stenosis is primarily based on the well-established functional diagnostic parameter, fractional flow reserve (FFR: ratio of pressures distal and proximal to a stenosis). The threshold of FFR has a "gray" zone of 0.75-0.80, below which further clinical intervention is recommended. An alternate diagnostic parameter, pressure drop coefficient (CDP: ratio of trans-stenotic pressure drop to the proximal dynamic pressure), developed based on fundamental fluid dynamics principles, has been suggested by our group. Additional serial stenosis, present downstream in a single vessel, reduces the hyperemic flow, Q˜h, and pressure drop, Δp˜, across an upstream stenosis. Such hemodynamic variations may alter the values of FFR and CDP of the upstream stenosis. Thus, in the presence of serial stenoses, there is a need to evaluate the possibility of misinterpretation of FFR and test the efficacy of CDP of individual stenoses. In-vitro experiments simulating physiologic conditions, along with human data, were used to evaluate nine combinations of serial stenoses. Different cases of upstream stenosis (mild: 64% area stenosis (AS) or 40% diameter stenosis (DS); intermediate: 80% AS or 55% DS; and severe: 90% AS or 68% DS) were tested under varying degrees of downstream stenosis (mild, intermediate, and severe). The pressure drop-flow rate characteristics of the serial stenoses combinations were evaluated for determining the effect of the downstream stenosis on the upstream stenosis. In general, Q˜h and Δp˜ across the upstream stenosis decreased when the downstream stenosis severity was increased. The FFR of the upstream mild, intermediate, and severe stenosis increased by a maximum of 3%, 13%, and 19%, respectively, when the downstream stenosis severity increased from mild to severe. The FFR of a stand-alone intermediate stenosis under a clinical setting is reported to be ∼0.72. In the presence of a downstream stenosis, the FFR values of the upstream intermediate stenosis were either within (0.77 for 80%-64% AS and 0.79 for 80%-80% AS) or above (0.88 for 80%-90% AS) the "gray" zone (0.75-0.80). This artificial increase in the FFR value within or above the "gray" zone for an upstream intermediate stenosis when in series with a clinically relevant downstream stenosis could lead to misinterpretation of functional stenosis severity. In contrast, a distinct range of CDP values was observed for each case of upstream stenosis (mild: 8-10; intermediate: 47-54; and severe: 130-155). The nonoverlapping range of CDP could better delineate the effect of the downstream stenosis from the upstream stenosis and allow for the accurate diagnosis of the functional severity of the upstream stenosis.

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Fractional Flow Reserve

Cited by 705 publications

References 48 publications

Numerical Investigation of the Effect of Stenosis Geometry on the Coronary Diagnostic Parameters

Numerical Investigation of the Effect of Stenosis Geometry on the Coronary Diagnostic Parameters

Functional Assessment of Coronary Arteries by Poststenotic Intravascular Doppler Ultrasound

Diagnostic Uncertainties During Assessment of Serial Coronary Stenoses: An In Vitro Study

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