Circulation, Vol 87, 1354-1367, Copyright © 1993 by American Heart Association
NH Pijls, JA van Son, RL Kirkeeide, B De Bruyne and KL Gould
BACKGROUND. Severity of coronary artery stenosis has been defined in terms
of geometric dimensions, pressure gradient-flow relations, resistance to
flow and coronary flow reserve, or maximum flow capacity after maximum
arteriolar vasodilation. A direct relation between coronary pressure and
flow, however, may only be presumed if the resistances in the coronary
circulation are constant (and minimal) as theoretically is the case during
maximum arteriolar vasodilation. In that case, pressure measurements
theoretically can be used to predict maximum flow and assess functional
stenosis severity. METHODS AND RESULTS. A theoretical model was developed
for the different components of the coronary circulation, and a set of
equations was derived by which the relative maximum flow or fractional flow
reserve in both the stenotic epicardial artery and the myocardial vascular
bed and the proportional contribution of coronary arterial and collateral
flow to myocardial blood flow are calculated from measurements of arterial,
distal coronary, and central venous pressures during maximum arteriolar
vasodilation. To test this model, five dogs were acutely instrumented with
an epicardial, coronary Doppler flow velocity transducer. Distal coronary
pressures were measured by an ultrathin pressure-monitoring guide wire
(0.015 in.) with minimal influence on transstenotic pressure gradient.
Fractional flow reserve was calculated from the pressure measurements and
compared with relative maximum coronary artery flow measured directly by
the Doppler flowmeter at three different levels of arterial pressure for
each of 12 different severities of stenosis at each pressure level.
Relative maximum blood flow through the stenotic artery (Qs) measured
directly by the Doppler flowmeter showed an excellent correlation with the
pressure-derived values of Qs (r = 0.98 +/- 0.01, intercept = 0.02 +/-
0.03, slope = 0.98 +/- 0.04), of the relative maximum myocardial flow (r =
0.98 +/- 0.02, intercept = 0.26 +/- 0.07, slope = 0.73 +/- 0.08), and of
the collateral blood flow (r = 0.96 +/- 0.04, intercept = 0.24 +/- 0.07,
slope = -0.24 +/- 0.06). Moreover, the theoretically predicted constant
relation between mean arterial pressure and coronary wedge pressure, both
corrected for venous pressure, was confirmed experimentally (r = 0.97 +/-
0.03, intercept = 9.5 +/- 13.3, slope = 4.4 +/- 1.2). CONCLUSIONS. These
results provide the experimental basis for determining relative maximum
flow or fractional flow reserve of both the epicardial coronary artery and
the myocardium, including collateral flow, from pressure measurements
during maximum arteriolar vasodilation. With a suitable guide wire for
reliably measuring distal coronary pressure clinically, this method may
have potential applications during percutaneous transluminal coronary
angioplasty for assessing changes in the functional severity of coronary
artery stenoses and for estimating collateral flow achievable during
occlusion of the coronary artery.
ARTICLES
Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty
Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands.
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B. De Bruyne, F. Hersbach, N. H.J. Pijls, J. Bartunek, J.-W. Bech, G. R. Heyndrickx, K. L. Gould, and W. Wijns Abnormal Epicardial Coronary Resistance in Patients With Diffuse Atherosclerosis but "Normal" Coronary Angiography Circulation, November 13, 2001; 104(20): 2401 - 2406. [Abstract] [Full Text] [PDF]
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T Pohl, P Hochstrasser, M Billinger, M Fleisch, B Meier, and C Seiler Influence on collateral flow of recanalising chronic total coronary occlusions: a case-control study Heart, October 1, 2001; 86(4): 438 - 443. [Abstract] [Full Text] [PDF]
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B. De Bruyne, N. H.J. Pijls, J. Bartunek, K. Kulecki, J.-W. Bech, H. De Winter, P. Van Crombrugge, G. R. Heyndrickx, and W. Wijns Fractional Flow Reserve in Patients With Prior Myocardial Infarction Circulation, July 10, 2001; 104(2): 157 - 162. [Abstract] [Full Text] [PDF]
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R. F. Wilson Looks Aren't Everything : FFR B4 U PTCA Circulation, June 19, 2001; 103(24): 2873 - 2875. [Full Text] [PDF]
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S. C. Smith Jr, J. T. Dove, A. K. Jacobs, J. Ward Kennedy, D. Kereiakes, M. J. Kern, R. E. Kuntz, J. J. Popma, H. V. Schaff, D. O. Williams, et al. ACC/AHA guidelines for percutaneous coronary intervention (revision of the 1993 PTCA guidelines): A report of the American College of Cardiology/ American Heart Association Task Force on practice guidelines (Committee to revise the 1993 guidelines for percutaneous transluminal coronary angioplasty) endorsed by the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2239 - 2239. [Full Text] [PDF]
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 N. van Royen, J. J. Piek, I. Buschmann, I. Hoefer, M. Voskuil, and W. Schaper Stimulation of arteriogenesis; a new concept for the treatment of arterial occlusive disease Cardiovasc Res, February 16, 2001; 49(3): 543 - 553. [Abstract] [Full Text] [PDF]
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M. Abe, H. Tomiyama, H. Yoshida, and N. Doba Diastolic Fractional Flow Reserve to Assess the Functional Severity of Moderate Coronary Artery Stenoses : Comparison With Fractional Flow Reserve and Coronary Flow Velocity Reserve Circulation, November 7, 2000; 102(19): 2365 - 2370. [Abstract] [Full Text] [PDF]
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N. H.J. Pijls, B. De Bruyne, G. J. W. Bech, F. Liistro, G. R. Heyndrickx, H. J.R.M. Bonnier, and J. J. Koolen Coronary Pressure Measurement to Assess the Hemodynamic Significance of Serial Stenoses Within One Coronary Artery : Validation in Humans Circulation, November 7, 2000; 102(19): 2371 - 2377. [Abstract] [Full Text] [PDF]
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A Wahl, M Billinger, M Fleisch, B Meier, and C Seiler Quantitatively assessed coronary collateral circulation and restenosis following percutaneous revascularization Eur. Heart J., November 1, 2000; 21(21): 1776 - 1784. [Abstract] [PDF]
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B. De Bruyne, N. H. J. Pijls, G. R. Heyndrickx, D. Hodeige, R. Kirkeeide, and K. L. Gould Pressure-Derived Fractional Flow Reserve to Assess Serial Epicardial Stenoses : Theoretical Basis and Animal Validation Circulation, April 18, 2000; 101(15): 1840 - 1847. [Abstract] [Full Text] [PDF]
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C. Whan Lee, S.-W. Park, G.-Y. Cho, M.-K. Hong, J.-J. Kim, D.-H. Kang, J.-K. Song, H.-J. Lee, and S.-J. Park Pressure-derived fractional collateral blood flow: a primary determinant of left ventricular recovery after reperfused acute myocardial infarction J. Am. Coll. Cardiol., March 15, 2000; 35(4): 949 - 955. [Abstract] [Full Text] [PDF]
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A. Jeremias, S. D. Filardo, R. J. Whitbourn, R. S. Kernoff, A. C. Yeung, P. J. Fitzgerald, and P. G. Yock Effects of Intravenous and Intracoronary Adenosine 5'-Triphosphate as Compared With Adenosine on Coronary Flow and Pressure Dynamics Circulation, January 25, 2000; 101(3): 318 - 323. [Abstract] [Full Text] [PDF]
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M. J. Kern, S. Puri, R. G. Bach, T. J. Donohue, P. Dupouy, E. A. Caracciolo, W. R. Craig, F. Aguirre, E. Aptecar, T. L. Wolford, et al. Abnormal Coronary Flow Velocity Reserve After Coronary Artery Stenting in Patients : Role of Relative Coronary Reserve to Assess Potential Mechanisms Circulation, December 21, 1999; 100(25): 2491 - 2498. [Abstract] [Full Text] [PDF]
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M. Fleisch, M. Billinger, F. R. Eberli, A. R. Garachemani, B. Meier, and C. Seiler Physiologically Assessed Coronary Collateral Flow and Intracoronary Growth Factor Concentrations in Patients With 1- to 3-Vessel Coronary Artery Disease Circulation, November 9, 1999; 100(19): 1945 - 1950. [Abstract] [Full Text] [PDF]
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M POULLIS Coronary pressure measurements: catheter induced errors Heart, November 1, 1999; 82(5): 644a - 645. [Full Text]
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C J Vrints, M J Claeys, J Bosmans, V Conraads, and J P Snoeck Effect of stenting on coronary flow velocity reserve: comparison of coil and tubular stents Heart, October 1, 1999; 82(4): 465 - 470. [Abstract] [Full Text] [PDF]
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A. Takagi, Y. Tsurumi, Y. Ishii, K. Suzuki, M. Kawana, and H. Kasanuki Clinical Potential of Intravascular Ultrasound for Physiological Assessment of Coronary Stenosis : Relationship Between Quantitative Ultrasound Tomography and Pressure-Derived Fractional Flow Reserve Circulation, July 20, 1999; 100(3): 250 - 255. [Abstract] [Full Text] [PDF]
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P. J. Scanlon, D. P. Faxon, A.-M. Audet, B. Carabello, G. J. Dehmer, K. A. Eagle, R. D. Legako, D. F. Leon, J. A. Murray, S. E. Nissen, et al. ACC/AHA guidelines for coronary angiography: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Coronary Angiography) developed in collaboration with the Society for Cardiac Angiography and Interventions J. Am. Coll. Cardiol., May 1, 1999; 33(6): 1756 - 1824. [Full Text] [PDF]
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C. E. E. Hanekamp, J. J. Koolen, N. H. J. Pijls, H. R. Michels, and H. J. R. M. Bonnier Comparison of Quantitative Coronary Angiography, Intravascular Ultrasound, and Coronary Pressure Measurement to Assess Optimum Stent Deployment Circulation, March 2, 1999; 99(8): 1015 - 1021. [Abstract] [Full Text] [PDF]
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N H J Pijls and B De Bruyne Coronary pressure measurement and fractional flow reserve Heart, December 1, 1998; 80(6): 539 - 542. [Full Text]
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H. G. Klues, E. R. Schwarz, J. vom Dahl, T. Reffelmann, H. Reul, K. Potthast, C. Schmitz, J. Minartz, W. Krebs, and i. Hanrath Disturbed Intracoronary Hemodynamics in Myocardial Bridging : Early Normalization by Intracoronary Stent Placement Circulation, November 4, 1997; 96(9): 2905 - 2913. [Abstract] [Full Text]
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B. de Bruyne, J. Bartunek, S. U. Sys, N. H.J. Pijls, G. R. Heyndrickx, and W. Wijns Simultaneous Coronary Pressure and Flow Velocity Measurements in Humans: Feasibility, Reproducibility, and Hemodynamic Dependence of Coronary Flow Velocity Reserve, Hyperemic Flow Versus Pressure Slope Index, and Fractional Flow Reserve Circulation, October 15, 1996; 94(8): 1842 - 1849. [Abstract] [Full Text]
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N. H.J. Pijls, B. de Bruyne, K. Peels, P. H. van der Voort, H. J.R.M. Bonnier, J. Bartunek, and J. J. Koolen Measurement of Fractional Flow Reserve to Assess the Functional Severity of Coronary-Artery Stenoses N. Engl. J. Med., June 27, 1996; 334(26): 1703 - 1708. [Abstract] [Full Text] [PDF]
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N. H.J. Pijls, B. Van Gelder, P. Van der Voort, K. Peels, F. A.L.E. Bracke, H. J.R.M. Bonnier, and M. I.H. El Gamal Fractional Flow Reserve : A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow Circulation, December 1, 1995; 92(11): 3183 - 3193. [Abstract] [Full Text]
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B. De Bruyne, J. Bartunek, S. U. Sys, and G. R. Heyndrickx Relation Between Myocardial Fractional Flow Reserve Calculated From Coronary Pressure Measurements and Exercise-Induced Myocardial Ischemia Circulation, July 1, 1995; 92(1): 39 - 46. [Abstract] [Full Text]
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H. Matsuo, S. Watanabe, T. Kadosaki, T. Yamaki, S. Tanaka, S. Miyata, T. Segawa, Y. Matsuno, M. Tomita, and H. Fujiwara Validation of Collateral Fractional Flow Reserve by Myocardial Perfusion Imaging Circulation, March 5, 2002; 105(9): 1060 - 1065. [Abstract] [Full Text] [PDF]
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