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This Article Full Text Full Text (PDF) All Versions of this Article: 289/1/H392    most recent 00798.2004v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Roy, A. S. Articles by Millard, R. W. Search for Related Content PubMed PubMed Citation Articles by Roy, A. S. Articles by Millard, R. W.

Delineating the guide-wire flow obstruction effect in assessment of fractional flow reserve and coronary flow reserve measurements

Departments of ¹Mechanical Engineering and ²Biomedical Engineering, ⁵Cardiac Catheterization Laboratory, Department of Cardiology, and ⁶Department of Pharmacology and Cell Biophysics, University of Cincinnati, Cincinnati, Ohio; ³Jet Propulsion Laboratory, California Institute of Technology, Pasadena, California; and ⁴Division of Vascular and Endovascular Surgery, University of South Florida, College of Medicine, Tampa, Florida

Submitted 5 August 2004 ; accepted in final form 23 February 2005

Hemodynamic analysis was conducted to determine uncertainty in clinical measurements of coronary flow reserve (CFR) and fractional flow reserve (FFR) over pathophysiological conditions in a patient group with coronary artery disease during angioplasty. The vasodilation-distal perfusion pressure (CFR-_rh) curve was obtained for 0.35- and 0.46-mm guide wires. Our hypothesis is that a guide wire spanning the lesions elevates the pressure gradient and reduces the flow during hyperemic measurements. Maximal CFR-_rh was uniquely determined by the intersection of measured CFR and calculated _rh of native and residual epicardial lesions in patients without microvascular disease, during angioplasty. Extrapolation of the linear curve gave a zero-coronary flow mean pressure (_zf) of 20 mmHg and a corresponding _rh of 55 mmHg in the native lesions, which coincided with the level that causes ischemia in human hearts. On this linear curve, values of CFR and FFR_myo (pathophysiological condition) and CFR_g and FFR_myog (in the presence of the guide wire) were obtained in native and residual lesions. A strong linear correlation was found between CFR and CFR_g [CFR = CFR_g x 0.689 + 1.271 (R² = 0.99) for 0.46 mm and CFR = CFR_g x 0.757 + 1.004 (R² = 0.99) for 0.35 mm] and between FFR_myo and FFR_myog [FFR_myo = FFR_myog x 0.737 + 0.263 (R² = 0.99) for 0.46 mm and FFR_myo = FFR_myog x 0.790 + 0.210 (R² = 0.99) for 0.35 mm]. This study establishes a strong correlation between CFR and CFR_g and between FFR_myo and FFR_myog, which could be used to obtain the true state of occlusion in the coronary artery during angioplasty.

hemodynamics; stenosis; microvascular impairment; pressure drop

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