EFFECT OF HEMODYNAMIC PARAMETERS ON FRACTIONAL FLOW RESERVE

2020 ◽  
Vol 20 (03) ◽  
pp. 2050017
Author(s):  
YUE FENG ◽  
BOYAN MAO ◽  
BAO LI ◽  
JIAN LIU ◽  
JINCHENG LIU ◽  
...  
Keyword(s):  
Mean Arterial Pressure ◽  
Myocardial Ischemia ◽  
Blood Vessel ◽  
Arterial Pressure ◽  
Fractional Flow Reserve ◽  
Resting State ◽  
Hemodynamic Parameters ◽  
Fractional Flow ◽  
Flow Reserve ◽  
The Mean

Background: The fractional flow reserve (FFR) is the gold standard used to diagnose whether coronary stenosis triggers myocardial ischemia. Myocardial ischemia is not only related to the degree of coronary artery disease but also to hemodynamic parameters such as mean arterial pressure, flow, and so on. This paper will explore the effects of hemodynamic parameters on FFR. Methods: Construct an ideal vascular model of moderately stenosis lesions (40–70%) with different hemodynamic environments. A pressure waveform was set as the inlet boundary, a microcirculation resistance in the hyperemia state was set as the outlet boundary, and different hemodynamic environments were constructed by changing the mean arterial pressure and flow at rest. The microcirculation resistance in the resting state was determined by the mean arterial pressure and flow, and the microcirculation resistance in the hyperemia state was 0.24 times than in the resting state. Results:Flow at rest was found to have the greatest impact on FFR, followed by arterial pressure. Both a decrease in flow and an increase in mean arterial pressure caused an increase in the FFR value. Conclusion:Based on the degree of stenosis of the diseased blood vessel, systolic pressure, diastolic blood pressure, and blood flow through the diseased blood vessel in the resting state, a preliminary judgment can be directly made as to whether the stenosis causes myocardial ischemia.

scholarly journals Ratiology and a Complementary Class of Metrics for Cardiovascular Investigations

Physiology ◽  
2019 ◽  
Vol 34 (4) ◽  
pp. 250-263 ◽  
Author(s):  
Peter L. M. Kerkhof ◽  
Richard A. Peace ◽  
Neal Handly
Keyword(s):  
Ejection Fraction ◽  
Arterial Pressure ◽  
Fractional Flow Reserve ◽  
Pulse Pressure ◽  
Augmentation Index ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Number Ratio ◽  
Single Number

Cardiovascular investigations often involve ratio-based metrics or differences: ejection fraction, arterial pressure augmentation index, coronary fractional flow reserve, pulse pressure. Focusing on a single number (ratio or difference) implies that information is lost. The lost companions constitute a well-defined but thus far unrecognized class, having additive value, a physical dimension, and often a physiological meaning. Physiologists should play a prominent role in exploring these complementary avenues and also define alternatives.

Abstract 2688: Can Stress Echocardiography With Tissue Characterization Evaluate Noncritical Coronary Stenosis? A Validation Study Against Simultaneous Measurement of Fractional Flow Reserve

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tudor Poerner ◽  
Sisi Vilardi ◽  
Björn Goebel ◽  
Hans R Figulla ◽  
Tim Süselbeck
Keyword(s):  
Myocardial Ischemia ◽  
Strain Rate ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Stress Echocardiography ◽  
Tissue Characterization ◽  
Fractional Flow ◽  
Balloon Inflation ◽  
Exercise Tests ◽  
Flow Reserve

Aim of this study was to evaluate the ability of different echocardiographic modalities to detect myocardial ischemia due to non-critical coronary stenosis, compared to the fractional flow reserve (FFR) as gold standard. Material and Methods: We investigated 22 consecutive patients presenting with stable angina, negative exercise tests and coronary 1-vessel disease with 50–75% diameter stenosis. TDE/SRI was performed at baseline and at peak hyperemia during 0.14 mg/kg/min adenosine infusion simultaneously with intracoronary FFR measurements. Angioplasty was carried out if FFR < 0.75, repeating TDE/SRI during first balloon inflation. Visual wall motion score, peak systolic values for myocardial velocity (Vs), strain rate (SRs), strain (Ss) and peak overall strain (Smax) were determined in the region of interest. Postsystolic shortening (PSS), accepted as typical marker of acute myocardial ischemia, was defined as (Smax-Ss)/Smax > 0.3, with reduced Ss < 15%. Results: Pathologic FFR < 0.75 was found in 11 patients (Table 1 ), who underwent angioplasty. Myocardial contractility reflected by SRs increased during hyperemia only in the patient group with FFR > 0.75 and decreased markedly during balloon inflation. Hyperemic SRs variation correlated with FFR (r = 0.5, p = 0.018) and predicted significantly pathologic FFR with an area under ROC curve of 0.86 (p <0.01). PSS was identified in 10 of 11 patients during vessel occlusion, but had a low sensitivity (2 of 11 patients with FFR < 0.75) for the more subtle changes during hyperemia. Conclusion: Functional assessment of moderate-to-severe coronary stenosis remains a diagnostic challenge. PSS occurrence cannot serve as a reliable noninvasive alternative to FFR. However, the blunted hyperemic variation of systolic strain rate was able to predict a pathologic FFR, even in this small group of patients. Therefore, TDE/SRI emerges as a promising tool to enhance the diagnostic accuracy of adenosine stress echocardiography. Table 1

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