(Circulation. 2001;103:184.)
© 2001 American Heart Association, Inc.
Brief Rapid Communications |
Role of Variability in Microvascular Resistance on Fractional Flow Reserve and Coronary Blood Flow Velocity Reserve in Intermediate Coronary Lesions
From the Departments of Cardiology and Medical Physics (J.A.E.S.), Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Correspondence to Jan J. Piek, MD, Department of Cardiology, B2-109, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail m.meuwissen{at}amc.uva.nl
Background—Fractional flow reserve (FFR) and coronary blood flow velocity reserve (CFR) represent physiological quantities used to evaluate coronary lesion severity and to make clinical decisions. A comparison between the outcomes of both diagnostic techniques has not been performed in a large cohort of patients with intermediate coronary lesions.
Methods and Results—FFR
and CFR were assessed in 126 consecutive patients with 150 intermediate
coronary lesions (between 40% and 70% diameter stenosis by visual
assessment). Agreement between outcomes of FFR and CFR, categorized at
cut-off values of 0.75 and 2.0, respectively, was observed in 109
coronary lesions (73%), whereas discordant outcomes were present in 41
lesions (27%). In 26 of these 41 lesions, FFR was <0.75 and CFR
2.0
(group A); in the remaining 15 lesions, FFR was 0.75 and CFR<2.0
(group B). Minimum microvascular resistance, defined as the
ratio of mean distal pressure to average peak blood flow velocity
during maximum hyperemia, showed a large variability (overall range,
0.65 to 4.64
mm Hg · cm-1 · s-1)
and was significantly higher in group B than in group A (2.42±0.77
versus 1.91±0.70
mm Hg · cm-1 · s-1;
P=0.034).
Conclusions—Our findings demonstrate the prominent role of microvascular resistance in modulating the relationship between FFR and CFR and emphasize the importance of combined pressure and flow velocity measurements to evaluate coronary lesion severity and microvascular involvement.
Key Words: coronary disease • blood flow • microcirculation
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