Influence of hemodynamic conditions on fractional flow  reserve: parametric analysis of underlying model

Siebes, Maria; Chamuleau, Steven A.J.; Meuwissen, Martijn; Piek, Jan J.; Spaan, Jos A. E.

doi:10.1152/ajpheart.00165.2002

Cited by 72 publications

(74 citation statements)

References 49 publications

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“…From Fig. 9A, it can be seen that FFR cannot delineate between ES and MVD, a conclusion similar to previous studies (17,18,20,28,29,38,41). However, the other two parameters, CDP (Fig.…”

Section: Discussionsupporting

confidence: 88%

“…hyperemic stenosis resistance is defined as the ratio of hyperemic mean transstenotic DP to the distal average peak velocity (APV). All the three parameters fail to delineate between the ES and the MVD conditions (17,18,28,29,38,41). In addition, in the presence of MVD, an increase in microvascular resistance at downstream myocardium leads to reduction of flow and CFR values in the upstream epicardial arteries.…”

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confidence: 96%

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Effect of heart rate on hemodynamic endpoints under concomitant microvascular disease in a porcine model

Peelukhana

Banerjee

Kolli

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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Diagnosis of the ischemic power of epicardial stenosis with concomitant microvascular disease (MVD) is challenging during coronary interventions, especially under variable hemodynamic factors like heart rate (HR). The goal of this study is to assess the influence of variable HR and percent area stenosis (%AS) in the presence of MVD on pressure drop coefficient (CDP; ratio of transstenotic pressure drop to the distal dynamic pressure) and lesion flow coefficient (LFC; ratio of %AS to the CDP at the throat region). We hypothesize that CDP and LFC are independent of HR. %AS and MVD were created using angioplasty balloons and 90-m microspheres, respectively. Simultaneous measurements of pressure drop (DP) and velocity were done in 11 Yorkshire pigs. Fractional flow reserve (FFR), CDP, and LFC were calculated for the groups HR Ͻ 120 and HR Ͼ 120 beats/min, %AS Ͻ 50 and %AS Ͼ 50, and additionally for DP Ͻ 14 and DP Ͼ 14 mmHg, and analyzed using regression and ANOVA analysis. Regression analysis showed independence between HR and the FFR, CDP, and LFC while it showed dependence between %AS and the FFR, CDP, and LFC. In the ANOVA analysis, for the HR Ͻ 120 beats/min and HR Ͼ 120 beats/min groups, the values of FFR (0.82 Ϯ 0.02 and 0.82 Ϯ 0.02), CDP (83.15 Ϯ 26.19 and 98.62 Ϯ 26.04), and LFC (0.16 Ϯ 0.03 and 0.15 Ϯ 0.03) were not significantly different (P Ͼ 0.05). However, for %AS Ͻ 50 and %AS Ͼ 50, the FFR (0.89 Ϯ 0.02 and 0.75 Ϯ 0.02), CDP (35.97 Ϯ 25.79.10 and 143.80 Ϯ 25.41), and LFC (0.09 Ϯ 0.03 and 0.22 Ϯ 0.03) were significantly different (P Ͻ 0.05). A similar trend was observed between the DP groups. Under MVD conditions, FFR, CDP, and LFC were not significantly influenced by changes in HR, while they can significantly distinguish %AS and DP groups.

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“…From Fig. 9A, it can be seen that FFR cannot delineate between ES and MVD, a conclusion similar to previous studies (17,18,20,28,29,38,41). However, the other two parameters, CDP (Fig.…”

Section: Discussionsupporting

confidence: 88%

mentioning

confidence: 96%

Effect of heart rate on hemodynamic endpoints under concomitant microvascular disease in a porcine model

Peelukhana

Banerjee

Kolli

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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“…18 Indeed, the original animal data showing the pressure independence of FFR has been reviewed using a Bland-Altman analysis, 19 demonstrating there can be a difference between pressure-based FFR and true flow-based FFR (Figure 2). …”

Section: Outcomes Of Ffr-guided Revascularizationmentioning

confidence: 99%

Advances in Coronary Physiology

Nijjer

Sen

Petraco

et al. 2015

Circ J

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Pressure-wire technology, most typically fractional flow reserve (FFR), has provided interventional cardiologists with a means of determining the physiological importance of a stenosis during angiography. There has been renewed interest in coronary physiology in the light of guideline recognition, ongoing clinical research and new technologies changing the paradigm of how assessment is performed in the catheter laboratory. We reflect on FFR, with regards the potential effects of changing hemodynamics on FFR and the latest evidence with regards to outcomes. We also review the instantaneous wave-free ratio (iFR), a new pressure-only index, measured at rest, that is under active evaluation in several international randomized controlled trials. We review the accumulated evidence and discuss the important physiological concepts between pressure and flow that underlie the approach to using resting indices. Finally we investigate future developments, including physiological mapping with iFR-Pullback and the potential to predict the hemodynamic effect of stenting. (Circ J 2015; 79: 1172 -1184

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“…FFR has previously been shown to be a reliable technique to functionally assess a given coronary intermediate stenosis with unclear hemodynamic significance (1,5). A previous report has suggested that coronary outflow pressure-corrected FFR cannot only be considered a specific index for the epicardial stenosis alone (32). FFR is also a function of myocardial bed resistance, which varies as a consequence of variable hemodynamic conditions (32).…”

Section: H404 Assessment Of Coronary Microcirculation In a Swine Modelmentioning

confidence: 99%

“…A previous report has suggested that coronary outflow pressure-corrected FFR cannot only be considered a specific index for the epicardial stenosis alone (32). FFR is also a function of myocardial bed resistance, which varies as a consequence of variable hemodynamic conditions (32). Therefore, FFR cannot be used as an independent index to assess microcirculation, since it is highly affected by the presence of an epicardial stenosis.…”

Section: H404 Assessment Of Coronary Microcirculation In a Swine Modelmentioning

confidence: 99%

Assessment of coronary microcirculation in a swine animal model

Zhang

Takarada

Molloi

2011

American Journal of Physiology-Heart and Circulatory Physiology

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Coronary microvascular dysfunction has important prognostic implications. Several hemodynamic indexes, such as coronary flow reserve (CFR), microvascular resistance, and zero-flow pressure (Pzf), were used to establish the most reliable index to assess coronary microcirculation. Fifteen swine were instrumented with a flow probe, and a pressure wire was advanced into the distal left anterior descending artery. Adenosine was used to produce maximum hyperemia. Microspheres were used to create microvascular dysfunction. An occluder was used to produce stenosis. Blood flow from the probe (Q p), aortic pressure, distal coronary pressure, and right atrium pressure were recorded. Angiographic flow (Q a) was calculated using a time-density curve. Flow probe-based CFR and angiographic CFR were calculated using Q p and Q a, respectively. Flow probe-based (NMRqh) and angiographic normalized microvascular resistance (NMRah) were determined using Q p and Q a, respectively, during hyperemia. Pzf was calculated using Q p and distal coronary pressure. Two series of receiver operating characteristic curves were generated: normal epicardial artery model (N model) and stenosis model (S model). The areas under the receiver operating characteristic curves for flow probe-based CFR, angiographic CFR, NMRqh, NMRah, and Pzf were 0. 855, 0.836, 0.976, 0.956, and 0.855 in N model and 0.737, 0.700, 0.935, 0.889, and 0.698 in S model. Both NMRqh and NMRah were significantly more reliable than CFR and Pzf in detecting the microvascular deterioration. Compared with CFR and Pzf, NMR provided a more accurate assessment of microcirculation. This improved accuracy was more prevalent when stenosis existed. Moreover, NMRah is potentially a less invasive method for assessing coronary microcirculation.angiography; blood flow; cardiovascular imaging; coronary microvascular function CORONARY ANGIOGRAPHY, a routine examination for patients with heart disease, provides an assessment of stenosis severity by visualizing the opacified arterial lumen. However, in many cases (12,40), the severity of myocardium ischemia correlates poorly with epicardial stenosis. Therefore, intracoronary physiological techniques have been developed to provide physiological evaluations for patients who undergo coronary angiography (8,34). Recently, the medical community's interest in coronary microcirculation has grown with the increasing awareness that microvascular dysfunction occurs in a number of myocardial disease states and has important prognostic implications (19,20). With this recognition comes the need for a method to accurately assess the functional capacity of coronary microcirculation for diagnostic purposes and to monitor the effects of therapeutic interventions targeted at reversing the extent of coronary microvascular dysfunction. To assess changes in the microcirculatory bed, several indexes have been proposed, such as coronary flow reserve (CFR), microvascular resistance (MR), and zero-flow pressure (P zf ). In the early 1990s, Gould et al. (14) introduced CFR...

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Influence of hemodynamic conditions on fractional flow reserve: parametric analysis of underlying model

Cited by 72 publications

References 49 publications

Effect of heart rate on hemodynamic endpoints under concomitant microvascular disease in a porcine model

Effect of heart rate on hemodynamic endpoints under concomitant microvascular disease in a porcine model

Advances in Coronary Physiology

Assessment of coronary microcirculation in a swine animal model

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