Abstract 12632: Impact of Systolic Pressure Response on Measurement of Fractional Flow Reserve

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tomoyuki Ikeda ◽  
Masafumi Ueno ◽  
Shinichiro Ikuta ◽  
Kosuke Fujita ◽  
Masakazu Yasuda ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Cardiac Cycle ◽  
Systolic Pressure ◽  
Pressure Response ◽  
The Other ◽  
Fractional Flow ◽  
Diastolic Phase ◽  
Flow Reserve ◽  
Significant Difference

Background: Fractional flow reserve (FFR) is calculated as the ratio between distal coronary pressure(Pd)and aortic pressure(Pa)during whole cardiac cycle at stable hyperemia. In clinical practice, we experience various Pd wave pattern during hyperemia, such as decreasing equally in systolic and diastolic phase, or mainly decreasing in diastolic phase. Purpose: The aim of the study was to evaluate the impact of systolic and diastolic pressure response during hyperemia in patients with coronary stenosis and an FFR of less than 0.8. Methods: A total of 35 patients (40 stenosis)had FFR of less than 0.8 were enrolled. FFR measurements were performed using a standard technique. Based on Pa and Pd wave forms, the decreasing area in systolic and diastolic were calculated by integrating Pa-Pd pressure gradient during hyperemia using the RadiView2.2 software. %Sys value was defined as the percentage of delta systolic area during the whole cardiac cycle (Figure). The results of %Sys values were divided into tertiles to evaluate the most significant factors for systolic pressure response. Results: Vessel distribution was as follows: LAD (60%), CX (20%) and RCA (20%). There was a significant difference of vessel distribution in coronary arteries in the upper tertile compared with the other two tertiles of %Sys values (p=0.028). However, the other factors such as FFR value, lesion length and severity, history of diabetes mellitus and previous myocardial infraction were not affected by the %Sys values. In addition, there was a significant difference of %Sys values among three major coronary arteries (LAD 49.4±18.5%, CX 81.5±38.7%, RCA 67.5±20.2%, p=0.006). %Sys values were significantly higher in non-LAD lesions compared with LAD lesions (74.5±30.7% vs 49.4±18.5%, p=0.003). Conclusions: There was a significant difference of decreasing pattern of Pd wave during hyperemia among the three coronary arteries. These findings suggest that iFR might not be accurate in non-LAD lesion.

Numerical simulation of fractional flow reserve in atherosclerotic coronary arteries

2021 ◽  
Author(s):  
Igor Saveljic ◽  
Tijana Djukic ◽  
Dalibor Nikolic ◽  
Smiljana Djorovic ◽  
Nenad Filipovic
Keyword(s):  
Numerical Simulation ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve

scholarly journals Impact of Inflow Boundary Conditions on the Calculation of CT-Based FFR

Fluids ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 60 ◽  
Author(s):  
Ernest Lo ◽  
Leon Menezes ◽  
Ryo Torii
Keyword(s):  
Boundary Conditions ◽  
Coronary Arteries ◽  
Three Dimensional ◽  
Patient Specific ◽  
Fractional Flow ◽  
Anatomical Models ◽  
Diastolic Phase ◽  
Flow Reserve ◽  
Population Average ◽  
The Impact

Background: Calculation of fractional flow reserve (FFR) using computed tomography (CT)-based 3D anatomical models and computational fluid dynamics (CFD) has become a common method to non-invasively assess the functional severity of atherosclerotic narrowing in coronary arteries. We examined the impact of various inflow boundary conditions on computation of FFR to shed light on the requirements for inflow boundary conditions to ensure model representation. Methods: Three-dimensional anatomical models of coronary arteries for four patients with mild to severe stenosis were reconstructed from CT images. FFR and its commonly-used alternatives were derived using the models and CFD. A combination of four types of inflow boundary conditions (BC) was employed: pulsatile, steady, patient-specific and population average. Results: The maximum difference of FFR between pulsatile and steady inflow conditions was 0.02 (2.4%), approximately at a level similar to a reported uncertainty level of clinical FFR measurement (3–4%). The flow with steady BC appeared to represent well the diastolic phase of pulsatile flow, where FFR is measured. Though the difference between patient-specific and population average BCs affected the flow more, the maximum discrepancy of FFR was 0.07 (8.3%), despite the patient-specific inflow of one patient being nearly twice as the population average. Conclusions: In the patients investigated, the type of inflow boundary condition, especially flow pulsatility, does not have a significant impact on computed FFRs in narrowed coronary arteries.

scholarly journals Prognostic value of renal fractional flow reserve in blood pressure response after renal artery stenting (PREFER study)

2013 ◽  
Vol 20 (4) ◽  
pp. 418-422 ◽  
Author(s):  
Jacek Kądziela ◽  
Andrzej Januszewicz ◽  
Aleksander Prejbisz ◽  
Ilona Michałowska ◽  
Magdalena Januszewicz ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Renal Artery ◽  
Fractional Flow Reserve ◽  
Prognostic Value ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Renal Artery Stenting

P5617Repeatability of instantaneous wave-free ratio in comparison with fractional flow reserve

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Horie ◽  
M Hoshino ◽  
H Hirano ◽  
Y Kanno ◽  
H Ohya ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Fractional Flow Reserve ◽  
Repeated Measurements ◽  
Mean Difference ◽  
Time Interval ◽  
Rater Agreement ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Significant Difference ◽  
Two Indices

Abstract Background Instantaneous wave-free ratio (iFR) has been recently introduced as an adenosine free alternative for fractional flow reserve (FFR) to assess the functional significance of epicardial coronary stenosis. Little is known, however, regarding the repeatability and stability of iFR in comparison with FFR. Purpose The aim of this study was to evaluate the repeatability of iFR and compare it to that of FFR. Methods Patients with stable coronary artery disease who underwent physiological assessment twice within 90 days were enrolled. Repeated measurements were performed at diagnostic and therapeutic catheterization in about 70% of studied population. The remaining patients were measured twice for non-culprit lesion assessment at primary PCI and subsequent non-culprit and ischemia-documented lesion PCI. The calculation of iFRmatlab from DICOM pressure tracing data of resting state was performed using a fully automated off-line software algorithm in a blind fashion. FFR values were also measured by a fully automated algorithm in the same core laboratory by using hyperemic pressure tracing data. The repeatability of the two indices were evaluated and compared. The inter-rater agreement between iFRmatlab and FFR values of two measurements was assessed by κ coefficient. The pressure rate product during each assessment was also documented and evaluated. Results Ninety-three lesions from 92 patients were included in the study. The time interval between the two assessments was 38.4±19.0 days. iFRmatlab and FFR both showed significant correlation within the two assessments (iFRmatlab: r=0.75, 95% confidence interval, 0.64 to 0.83; mean difference, −0.006 [−0.18 to −0.01], FFR: r=0.86, 95% confidence interval, 0.79 to 0.90; mean difference, 0.004 [−0.07 to 0.03]). The inter-rater agreement of functional ischemia for iFRmatlab and FFR were κ=0.449 and κ=0.732, respectively. Although the prevalence of functional ischemia during the first and second assessment were consistent for both indices (iFRmatlab: 70.0%/67.7%, FFR: 86.0%/ 86.0%), significant difference was observed in the prevalence of clinical disagreement on the diagnosis of functional ischemia (FFR=0.80, iFR=0.89 used as cut-off values, respectively) between the first and second assessment among the two indices (iFRmatlab: 6.5%, FFR: 23.7%, p=0.002). iFRmatlab was significantly associated with pressure rate product during the examination compared to FFR (iFRmatlab: r= −0.25, 95% confidence interval, −0.43 to −0.04, P=0.018, FFR: r=−0.08, 95% confidence interval, −0.28 to −0.13, p=0.467). Conclusion Our results suggested that iFRmatlab showed lower repeatability and reliability for decision making compared to FFR. The instability of iFRmatlab potentially derives at least in part from its association with heart rate and blood pressure product.

Comparison of fractional flow reserve, instantaneous wave-free ratio and a novel technique for assessing coronary arteries with serial lesions

2020 ◽  
Vol 16 (7) ◽  
pp. 577-583
Author(s):  
Bhavik N. Modi ◽  
Haseeb Rahman ◽  
Matthew Ryan ◽  
Howard Ellis ◽  
Antonis Pavlidis ◽  
...  
Keyword(s):  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Novel Technique ◽  
Flow Reserve

Fractional Flow Reserve Estimation in Coronary Arteries by Forward Geometrical Modeling

2013 ◽  
Author(s):  
Jelle T. C. Schrauwen ◽  
Jolanda J. Wentzel ◽  
Anton F. W. van der Steen ◽  
Frank J. H. Gijsen
Keyword(s):  
Clinical Practice ◽  
Pressure Drop ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Reserve Estimation ◽  
Important Indicator ◽  
Flow Reserve ◽  
Pressure Wire

Fractional Flow Reserve (FFR) is an important indicator for the hemodynamic significance of a coronary stenosis [1]. The FFR is defined as the pressure drop over the stenosis under hyperemia. The pressure drop, and thus the FFR, depends on both the geometry and flow. In clinical practice, the FFR is measured with a pressure wire under administration of adenosine and intervention is warranted if the FFR is below 0.8.

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