Ability of Fractional Flow Reserve to Predict Restenosis After Superficial Femoral Artery Stenting

2016 ◽  
Vol 23 (6) ◽  
pp. 896-902 ◽  
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masahiro Yamawaki ◽  
Motoharu Araki ◽  
Tsuyoshi Sakai ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Femoral Artery ◽  
Roc Curve ◽  
Superficial Femoral Artery ◽  
Systolic Pressure ◽  
Fractional Flow ◽  
Roc Curve Analysis ◽  
Flow Reserve ◽  
Mean Pressure ◽  
The Relationship

Purpose: To evaluate the clinical efficacy of poststenting fractional flow reserve (FFR) in terms of predicting restenosis in superficial femoral artery (SFA) disease. Methods: This prospective, single-center, nonrandomized study enrolled 48 patients (mean age 76±9 years; 38 men) with 51 SFA lesions from July 2013 to June 2014. Mean FFR (distal mean pressure/proximal mean pressure) and systolic FFR (distal systolic pressure/proximal systolic pressure) were calculated, and the relationship between these FFR values and restenosis at 12 months was investigated using receiver operating characteristic (ROC) curve analysis. Results: Poststenting FFR was significantly lower in the restenosis group (poststenting mean FFR 0.85±0.07 vs 0.93±0.05, p=0.001; poststenting systolic FFR 0.76±0.14 vs 0.87±0.08, p=0.015). The area under the ROC curve for restenosis in poststenting mean FFR was higher, but not statistically significant, than that in poststenting systolic FFR (0.84 vs 0.74, p=0.08). The best poststenting mean FFR cutoff value for predicting restenosis was 0.92 (sensitivity 0.64, specificity 0.91). The 4.5% restenosis rate at 12 months in the high (>0.92) poststenting mean FFR group was significantly lower (35.7%, p=0.008) than in the low (≤0.92) poststenting mean FFR group. Conclusion: Poststenting mean FFR is useful for predicting restenosis in SFA disease.

scholarly journals Measuring Procedure and Maximal Hyperemia in the Assessment of Fractional Flow Reserve for Superficial Femoral Artery Disease

2016 ◽  
Vol 23 (1) ◽  
pp. 56-66 ◽  
Author(s):  
Norihiro Kobayashi ◽  
Keisuke Hirano ◽  
Masatsugu Nakano ◽  
Yoshiaki Ito ◽  
Tsuyoshi Sakai ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Fractional Flow ◽  
Measuring Procedure ◽  
Flow Reserve ◽  
Artery Disease

The relationship between the basal coronary translesional pressure ratio and fractional flow reserve

2017 ◽  
Vol 90 (5) ◽  
pp. 745-753 ◽  
Author(s):  
William M. Wilson ◽  
Anoop S. V. Shah ◽  
Duncan Birse ◽  
Emma Harley ◽  
David B. Northridge ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Pressure Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
The Relationship

scholarly journals The relationship between coronary stenosis morphology and fractional flow reserve: a computational fluid dynamics modelling study

2021 ◽  
Author(s):  
Roberto T F Newcombe ◽  
Rebecca C Gosling ◽  
Vignesh Rammohan ◽  
Patricia V Lawford ◽  
D Rodney Hose ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Computational Modelling ◽  
Fractional Flow ◽  
Cfd Modelling ◽  
Flow Reserve ◽  
The Relationship ◽  
Lesion Severity

Abstract Background International guidelines mandate the use of fractional flow reserve (FFR) and/or non-hyperaemic pressure ratios to assess the physiological significance of moderate coronary artery lesions to guide revascularisation decisions. However, they remain underused such that visual estimation of lesion severity continues to be the predominant decision-making tool. It would be pragmatic to have an improved understanding of the relationship between lesion morphology and haemodynamics. Aims To compute virtual FFR (vFFR) in idealised coronary artery geometries with a variety of stenosis and vessel characteristics Methods Coronary artery geometries were modelled, based upon physiologically realistic branched arteries. Common stenosis characteristics were studied, including % narrowing, length, eccentricity, shape, number, position relative to branch, and distal (myocardial) resistance. Computational fluid dynamics (CFD) modelling was used to calculate vFFRs using the VIRTUheartTM system. Results Percentage lesion severity had the greatest effect upon FFR. Any ≥80% diameter stenosis in two views (i.e. concentric) was physiologically significant (FFR ≤ 0.80), irrespective of length, shape or vessel diameter. Almost all eccentric stenoses and all 50% concentric stenoses were physiologically non-significant, whilst 70% uniform concentric stenoses about 10mm long straddled the ischaemic threshold (FFR 0.80). A low microvascular resistance (MVR) reduced FFR on average by 0.05, and a high MVR increased it by 0.03. Conclusions Using computational modelling, we have produced an analysis of virtual FFR that relates stenosis characteristics to haemodynamic significance. The strongest predictor of a positive virtual FFR was a concentric, ≥80% diameter stenosis. The importance of MVR was quantified. Other lesion characteristics have a limited impact.

scholarly journals The Relationship between Fractional Flow Reserve, Platelet Reactivity and Platelet Leukocyte Complexes in Stable Coronary Artery Disease

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e83198 ◽  
Author(s):  
Jan-Willem E. M. Sels ◽  
Bert Rutten ◽  
Thijs C. van Holten ◽  
Marieke A. K. Hillaert ◽  
Johannes Waltenberger ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Platelet Reactivity ◽  
Stable Coronary Artery Disease ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Artery Disease ◽  
The Relationship

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.

scholarly journals The imortance of hyperemic contrast velocity assessment on image-based fractional flow reserve calculation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Tar ◽  
A Uveges ◽  
Z Koszegi
Keyword(s):  
Fractional Flow Reserve ◽  
Three Dimensional ◽  
Microvascular Disease ◽  
Simple Calculation ◽  
Fractional Flow ◽  
Roc Curve Analysis ◽  
Flow Reserve ◽  
Myocardial Area ◽  
Pressure Wire ◽  
The Difference

Abstract Aims Image-based fractional flow reserve (FFR) calculations reported good agreement with FFR measured invasively. The purpose of this study was to perform a retrospective analysis of the cases of a previous study on less invasive FFR calculation (simple FFR: FFRsim) as a simple calculation from hyperemic contrast flow data and three-dimensional coronary parameters. Methods and results We aimed to analyze the relations between the pressure wire-based FFR (FFRmeas) and fixed FFRsim: calculated from the fixed hyperemic velocity, rest FFRsim: calculated using the non-hyperemic frame count data to extrapolate the hyperemic velocity (based on the database used in the FAVOR1 study) hyp FFRsim: the hyperemic velocity derived from the frame count assessment during vasodilation.To calculate the frame count reserve (CFRFC) the resting frame count was divided by the hyperemic frame count; this value was then used to determine the CFRFC/FFRmeas ratio as an indicator of microvascular function in the corresponding myocardial area of the measured coronary vessel. A total of 50 lesions with intermediate stenosis were investigated. Correlation between rest FFRsim (from the resting frame count extrapolated to the hyperemic velocity) and FFRmeas was lower than the correlation between hyp FFRsim and FFRmeas (r=0.761 vs. 0.824). Based on ROC curve analysis for predicting the abnormal FFR of ≤0.80 the AUC were significantly higher for the hyperemia-based parameter than those calculated from resting frame counts. Significantly higher AUC were detected by the hyp FFRsim than by the rest FFRsim: 0.936 (95% CI: 0.828 to 0.985) vs. 0.862 (CI: 0.734 to 0.943); p=0.011. Linear regression analyses between the FFRsim (either by fixed FFRsim or by rest FFRsim or by hyp FFRsim methods) and the FFRmeas showed higher intercepts and less steep of the slopes in the subgroups with presence of microvascular disease defined as CFRFC/FFRmeas <2 than in those without microvascular disease (CFRFC/FFRmeas >2); the difference reached significant level (p=0.019) when calculated by rest FFRsim. Conclusions Hyperemic challenge either by adenosine or regadenoson is required for exact image-based FFR calculation especially in cases of suspicion for microvascular coronary disease. Funding Acknowledgement Type of funding source: None

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