scholarly journals Comparison Between 5- and 1-Year Outcomes Using Cutoff Values of Pressure Drop Coefficient and Fractional Flow Reserve for Diagnosing Coronary Artery Diseases

2021 ◽  
Vol 12 ◽  
Author(s):  
Rupak K. Banerjee ◽  
Sruthi Ramadurai ◽  
Shreyash M. Manegaonkar ◽  
Marepalli B. Rao ◽  
Sathyaprabha Rakkimuthu ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Pressure Drop ◽  
Patient Group ◽  
Fractional Flow Reserve ◽  
Statistical Significance ◽  
Flow Index ◽  
Fractional Flow ◽  
Cardiac Catheterization Laboratory ◽  
Flow Reserve ◽  
Diagnostic Index

BackgroundThe current pressure-based coronary diagnostic index, fractional flow reserve (FFR), has a limited efficacy in the presence of microvascular disease (MVD). To overcome the limitations of FFR, the objective is to assess the recently introduced pressure drop coefficient (CDP), a fundamental fluid dynamics-based combined pressure–flow index.MethodsWe hypothesize that CDP will result in improved clinical outcomes in comparison to FFR. To test the hypothesis, chi-square test was performed to compare the percent major adverse cardiac events (%MACE) at 5 years between (a) FFR < 0.75 and CDP > 27.9 and (b) FFR < 0.80 and CDP > 25.4 groups using a prospective cohort study. Furthermore, Kaplan–Meier survival curves were compared between the FFR and CDP groups. The results were considered statistically significant for p < 0.05. The outcomes of the CDP arm were presumptive as clinical decision was solely based on the FFR.ResultsFor the complete patient group, the %MACE in the CDP > 27.9 group (10 out of 35, 29%) was lower in comparison to the FFR < 0.75 group (11 out of 20, 55%), and the difference was near significant (p = 0.05). The survival analysis showed a significantly higher survival rate (p = 0.01) in the CDP > 27.9 group (n = 35) when compared to the FFR < 0.75 group (n = 20). The results remained similar for the FFR = 0.80 cutoff. The comparison of the 5-year MACE outcomes with the 1-year outcomes for the complete patient group showed similar trends, with a higher statistical significance for a longer follow-up period of 5 years.ConclusionBased on the MACE and survival analysis outcomes, CDP could possibly be an alternate diagnostic index for decision-making in the cardiac catheterization laboratory.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT01719016.

scholarly journals Right atrial pressure: Can it be ignored when calculating fractional flow reserve and collateral flow index?

2004 ◽  
Vol 44 (10) ◽  
pp. 2089-2091 ◽  
Author(s):  
Divaka Perera ◽  
Simon Biggart ◽  
Pieter Postema ◽  
Sundip Patel ◽  
Pier Lambiase ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Flow Index ◽  
Collateral Flow ◽  
Fractional Flow ◽  
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.

Influence of contractility and heart rate on pressure drop coefficient and fractional flow reserve for epicardial stenosis

2010 ◽  
Vol 11 (3) ◽  
pp. 214 ◽  
Author(s):  
Kranthi K. Kolli ◽  
Tarek Helmy ◽  
Mohamed Effat ◽  
Arif Imran ◽  
Massoud Leesar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pressure Drop ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Epicardial Stenosis

Assessment of Invasive Fractional Flow Reserve Procedures Using Computational Fluid Dynamics

2020 ◽  
Author(s):  
Yasser Abuouf ◽  
Muhamed Albadawi ◽  
Shinichi Ookawara ◽  
Mahmoud Ahmed
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Pressure Drop ◽  
Fractional Flow Reserve ◽  
Treatment Plan ◽  
Three Dimensional ◽  
Patient Specific ◽  
Concomitant Treatment ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Coronary artery disease is the abnormal contraction of heart supply blood vessel. It may lead to major consequences such as heart attack and death. This narrowing in the coronary artery limits the oxygenated blood flow to the heart. Thus, diagnosing its severity helps physicians to select the appropriate treatment plan. Fractional Flow Reserve (FFR) is one of the most accurate methods to pinpoint the stenosis severity. The advantages of FFR are high accuracy, immediate estimation of the severity of the stenosis, and concomitant treatment using balloon or stent. Nevertheless, the main disadvantage of the FFR is being an invasive procedure that requires an incision under anesthesia. Moreover, inserting the guidewire across the stenosis may result in a ‘tight-fit’ between the vessel lumen and the guidewire. This may cause an increase in the measured pressure drop, leading to a false estimation of the blood flow parameters. To estimate the errors in diagnosis procedures, a comprehensive three-dimensional model blood flow along with guidewire is developed. Reconstructed three-dimensional coronary artery geometry from a patient-specific scan is used. Blood is considered non-Newtonian and the flow is pulsatile. The comprehensive model is numerically simulated using boundary conditions. Based on the predicted results, the ratio between pressure drop and distal dynamic pressure (CDP) is studied. The predicted results for each case are compared with the control case (the case without guidewire) and analyzed. It was found that simulating the model by placing the guidewire at a full position prior to the simulation leads to an overestimation of the CDP as it increases by 34.3%. However, simulating the procedure of guidewire insertion is more accurate. It shows that the CDP value increases by 7%.

scholarly journals Change in Computed Tomography-Derived Fractional Flow Reserve Across the Lesion Improve the Diagnostic Performance of Functional Coronary Stenosis

2022 ◽  
Vol 8 ◽  
Author(s):  
Hankun Yan ◽  
Yang Gao ◽  
Na Zhao ◽  
Wenlei Geng ◽  
Zhihui Hou ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Diagnostic Performance ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Youden Index ◽  
Reference Standard ◽  
Fractional Flow ◽  
Flow Reserve

Aims: This study sought to evaluate the diagnostic performance of change in computed tomography-derived fractional flow reserve (CT-FFR) across the lesion (ΔCT-FFR) for identifying ischemia lesions with FFR as the reference standard.Methods: Patients who underwent coronary CT angiography (CCTA) and FFR measurement within 1 week from December 2018 to December 2019 were retrospectively enrolled. CT-FFR within 2 cm distal to the lesion, ΔCT-FFR and plaque characteristics were analyzed. The diagnostic accuracy of CCTA (coronary stenosis ≥ 50%), CT-FFR ≤ 0.80, and ΔCT-FFR ≥ 0.15 (based on the largest Youden index) were assessed with FFR as the reference standard. The relationship between plaque characteristics and ΔCT-FFR was analyzed.Results: The specificity of ΔCT-FFR and CT-FFR were 70.8 and 67.4%, respectively, which were both higher than CCTA (39.3%) (both P < 0.001), while there were no statistical significance in sensitivity among the three (84.5, 77.4, 88.1%, respectively; P = 0.08). The area under the curves (AUCs) of ΔCT-FFR and CT-FFR were 0.803 and 0.743, respectively, which were both higher than that of CCTA (0.637) (both P < 0.05), and the AUC of ΔCT-FFR was higher than that of CT-FFR (P < 0.001). Multivariable analysis showed that low-attenuation plaque (LAP) volume (odds ratio [OR], 1.006) and plaque length (OR, 1.021) were independently correlated with ΔCT-FFR (both P < 0.05).Conclusions: CT-FFR and ΔCT-FFR and here especially the ΔCT-FFR could improve the diagnostic performance of ischemia compared with CCTA alone. LAP volume and plaque length were the independent risk factors of ΔCT-FFR.

scholarly journals Fractional Flow Reserve Method in Cardiac Catheterization Laboratory without Cardiosurgical Backup: Initial Experiences

2013 ◽  
Vol 1 (1) ◽  
pp. 50-53
Author(s):  
Ivan Simic ◽  
Vladimir Zdravkovic ◽  
Rada Vucic ◽  
Violeta Iric-Cupic ◽  
Goran Davidovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Myocardial Revascularization ◽  
Quantitative Coronary Angiography ◽  
Modern World ◽  
Heart Team ◽  
Fractional Flow ◽  
Catheterization Laboratory ◽  
Cardiac Catheterization Laboratory ◽  
Flow Reserve

Background: Coronary artery disease is the most common cause of death in a modern world. This dictates the development a network of Catheterization laboratories without cardiosurgical capabilities.Aim: We postulate that the most valuable tool in the decision process on myocardial revascularization is fractional flow reserve (FFR), especially when we deal with borderline coronary lesions.Material and Methods: A total of 72 patients with 94 intermediate coronary stenosis (30%-70% diameter reduction) were included in this study. We tested FFR and angiography based decision model on myocardial revascularization.Results:  Mean FFR value on left anterior descending coronary artery (LAD) was lower than in others two arteries (p=0.017). FFR after percutaneous coronary intervention (PCI) was significantly better (p<0.0001). The decision for PCI predominates before FFR diagnostics, but after FFR the decision is quite opposite. There is a weak negative correlation between FFR and diameter of stenosis assessed by angiography (r= - 0.245 p=0.038) and positive correlation between diameter of stenosis assessed by angiography and by quantitative coronary angiography (QCA) (r=0.406 p<0.0005).Conclusion:  Our results strongly suggest that FFR is necessary tool in centers without possibilities of heart team onsite consultation and that prevents numerous unnecessary PCI.

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