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Am J Physiol Heart Circ Physiol (May 23, 2002). doi:10.1152/ajpheart.00165.2002
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Articles in PresS, published online ahead of print May 23, 2002
Am J Physiol Heart Circ Physiol, 10.1152/ajpheart.00165.2002
Submitted on February 27, 2002
Accepted on May 20, 2002

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

Maria Siebes1*, Steven A. Chamuleau2, Martijn Meuwissen2, Jan J. Piek2, and Jos A.E. Spaan3

1 Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Medical Physics, Academic Medical Center, Amsterdam, The Netherlands
2 Cardiology, Academic Medical Center, Amsterdam, The Netherlands
3 Medical Physics, Academic Medical Center, Amsterdam, The Netherlands

* To whom correspondence should be addressed. E-mail: m.siebes{at}amc.uva.nl.

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 since 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/min), aortic pressure (Pa = 70 - 100 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 hemodynamic changes was highest for stenoses of intermediate severity. For Pb > 0, FFR progressively exceeded Qs/Qn with increasing stenosis severity unless FFR was corrected for a nonzero Pb. Although the Pb-corrected FFR equalled Qs/Qn for a given stenosis, both parameters remained equally influenced by hemodynamic conditions through their direct relationship to both stenosis and coronary resistance.




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