(Circulation. 2000;102:2371.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Coronary Pressure Measurement to Assess the Hemodynamic Significance of Serial Stenoses Within One Coronary Artery
Validation in Humans
From the Department of Cardiology, Catharina Hospital (N.H.J.P., G.J.W.B., F.L., H.J.R.M.B, J.J.K.), and the Department of Biomedical Engineering, Eindhoven University of Technology (N.H.J.P.), Eindhoven, The Netherlands, and the Department of Cardiology, Cardiovascular Center Aalst, Belgium (B.D.B., G.R.H.).
Background—When several stenoses are present within 1 coronary artery, the hemodynamic significance of each stenosis is influenced by the presence of the other(s), and the calculation of coronary and fractional flow reserve (CFR and FFR) for each individual stenosis is confounded. Recently, we developed and experimentally validated a method to determine the true FFR of each stenosis as it would be after the removal of the other stenosis; the true FFR can be reliably predicted by coronary pressures measured before treatment at specific locations within the coronary artery using equations accounting for stenosis interaction. The aim of the present study was to test the validity of these equations in humans.
Methods and Results—In this study of 32 patients with 2 serial
stenoses in 1 coronary artery, relevant pressures were
measured before the intervention, after the treatment of 1
stenosis, and after the treatment of both stenoses. The
true FFR of each stenosis (FFRtrue) was directly
measured after the elimination of the other stenosis and
compared with the value predicted (FFRpred) from the
initial pressure measurements before treatment. Although the
hyperemic gradient across 1 stenosis increased
significantly (from 10±7 to 19±11 mm Hg after treatment of the
other stenosis), FFRpred was close to
FFRtrue in all patients (0.78±0.12 versus 0.78±0.11
mm Hg; r=0.92; 
%=4±0%). Without accounting for
stenosis interaction, the value of FFR for each
stenosis would have been significantly overestimated
(0.85±0.08; P<0.01).
Conclusions—Coronary pressure measurements made by a pressure wire at maximum hyperemia provide a simple, practical method for assessing the individual hemodynamic significance of multiple stenoses within the same artery.
Key Words: pressure • stenosis • blood flow
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