Abstract
Fractional flow reserve has shown to be a gold standard in assessment of functional significance of coronary artery stenosis. Lesion eccentricity is an important geometric parameter which may affect the translational hemodynamics. Three dimensional quantitative coronary angiography (3D-QCA) was used to reconstruct the proximal or mid left anterior descending artery of 56 patients. The fractional flow reserve (FFR) was measured using pressure–temperature sensor guidewire and the effects of lesion eccentricity (EI) was investigated on the correlation between FFR diameter stenosis (DS), area stenosis (AS), minimum lumen diameter (MLD) and minimum lumen area (MLA). A linear regression analysis showed a non-significant correlation between FFR and DS, AS, MLD and MLA. In order to improve the correlations, a receiver operating characteristic (ROC) curve analysis was used to identify the best cut-off value of eccentricity to predict FFR ≤ 0.75. It was found that for lesions whose eccentricity is above the cut-off, the correlations are significant; however, the correlations are weak for lesions with eccentricity below the cut-off.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Topol, E.J., Nissen, S.E.: Our preoccupation with coronary luminology. The dissociation between clinical and angiographic findings in ischemic heart disease. Circulation 92, 2333–2342 (1995)
Berger, A., et al.: Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. J. Am. Coll. Cardiol. 46, 438–442 (2005)
Pijls, N.H., et al.: Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J. Am. Coll. Cardiol. 49, 2105–2111 (2007)
Potvin, J.M., et al.: Usefulness of fractional flow reserve measurements to defer revascularization in patients with stable or unstable angina pectoris, non-ST-elevation and ST-elevation acute myocardial infarction, or atypical chest pain. Am. J. Cardiol. 98, 289–297 (2006)
Shaw, L.J., et al.: Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117(10), 1283–1291 (2008)
Li, F., et al.: The association of lesion eccentricity with plaque morphology and components in the superficial femoral artery: a high-spatial-resolution, multi-contrast weighted CMR study. J. Cardiovasc. Magn. Reson. 12, 37 (2010)
Yamagishi, M., et al.: Morphology of vulnerable coronary plaque: insights from follow-up of patients examined by intravascular ultrasound before an acute coronary syndrome. J. Am. Coll. Cardiol. 35(1), 106–111 (2000)
Brosh, D., et al.: Effect of lesion length on fractional flow reserve in intermediate coronary lesions. Am. Heart J. 150, 338–343 (2004)
Kolozsvari, R., et al.: Plaque volume derived from three-dimensional reconstruction of coronary angiography predicts the fractional flow reserve. Int. J. Cardiol. (2011). doi:10.1016/j.ijcard.2011.04.010
Briguori, C., et al.: Intravascular ultrasound criteria for the assessment of the functional significance of intermediate coronary artery stenoses and comparison with fractional flow reserve. Am. J. Cardiol. 87, 136–141 (2001)
Jasti, V., et al.: Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis. Circulation 110, 2831–2836 (2004)
Takagi, A., et al.: Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis: relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve. Circulation 100, 250–255 (1999)
Tobis, J., et al.: Assessment of intermediate severity coronary lesions in the catheterization laboratory. J. Am. Coll. Cardiol. 49, 839–848 (2007)
Lamm, C., et al.: High-fidelity translesional pressure gradients during percutaneous transluminal coronary angioplasty: correlation with quantitative coronary angiography. Am. Heart J. 126, 66–75 (1993)
Hanekamp, C.E.E., et al.: Comparison of quantitative coronary angiography, intravascular ultrasound, and coronary pressure measurement to assess optimum stent deployment. Circulation 99, 1015–1021 (1999)
Abizaid, A., et al.: Clinical, intravascular ultrasound and quantitative angiographic determinants of the coronary flow reserve before and after percutaneous transluminal coronary angioplasty. Am. J. Cardiol. 82, 423–428 (1998)
Moses, J.W., et al.: Relation between single tomographic intravascular ultrasound image parameters and intracoronary Doppler flow velocity in patients with intermediately severe coronary stenoses. Am. Heart J. 135, 988–994 (1998)
Yong, A.S.C., et al.: Three-dimensional and two-dimensional quantitative coronary angiography, and their prediction of reduced fractional flow reserve. Eur. Heart J. 32(3), 345–353 (2011)
Javadzadegan, et al.: Flow recirculation zone length and shear rate are differentially affected by stenosis severity in human coronary arteries. Am. J. Physiol. Heart Circ. Physiol. 304, 559–566 (2013)
Ng, M.K., et al.: Invasive assessment of the coronary microcirculation: superior reproducibility and less hemodynamic dependence of index of microcirculatory resistance compared with coronary flow reserve. Circulation 113(17), 2054–2061 (2006)
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Javadzadegan, A., Yong, A.S.C., Kritharides, L., Behnia, M. (2013). Lesion Eccentricity and Fractional Flow Reserve and Coronary Flow Reserve in Coronary Arteries. In: Ochsner, A., Altenbach, H. (eds) Advances in Bio-Mechanical Systems and Materials. Advanced Structured Materials, vol 40. Springer, Cham. https://doi.org/10.1007/978-3-319-00479-2_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-00479-2_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-00478-5
Online ISBN: 978-3-319-00479-2
eBook Packages: Chemistry and Materials ScienceChemistry and Material Science (R0)