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Am J Physiol Heart Circ Physiol 283: H1462-H1470, 2002. First published May 23, 2002; doi:10.1152/ajpheart.00165.2002
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Vol. 283, Issue 4, H1462-H1470, October 2002

Influence of hemodynamic conditions on fractional flow reserve: parametric analysis of underlying model

Maria Siebes1,2, Steven A. J. Chamuleau1, Martijn Meuwissen1, Jan J. Piek1, and Jos A. E. Spaan2

Departments of 1 Cardiology and 2 Medical Physics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands

Pressure-based fractional flow reserve (FFR) is used clinically to evaluate the functional severity of a coronary stenosis, by predicting relative maximal coronary flow (Qs/Qn). It is considered to be independent of hemodynamic conditions, which seems unlikely because stenosis resistance is flow dependent. Using a resistive model of an epicardial stenosis (0-80% diameter reduction) in series with the coronary microcirculation at maximal vasodilation, we evaluated FFR for changes in coronary microvascular resistance (Rcor = 0.2-0.6 mmHg · ml-1 · min), aortic pressure (Pa = 70-130 mmHg), and coronary outflow pressure (Pb = 0-15 mmHg). For a given stenosis, FFR increased with decreasing Pa or increasing Rcor. The sensitivity of FFR to these hemodynamic changes was highest for stenoses of intermediate severity. For Pb > 0, FFR progressively exceeded Qs/Qn with increasing stenosis severity unless Pb was included in the calculation of FFR. Although the Pb-corrected FFR equaled Qs/Qn for a given stenosis, both parameters remained equally dependent on hemodynamic conditions, through their direct relationship to both stenosis and coronary resistance.

coronary artery stenosis; coronary circulation; coronary stenosis evaluation; coronary flow reserve


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