Clinical InvestigationInterventional CardiologyEffect of lesion length on fractional flow reserve in intermediate coronary lesions
Section snippets
Patients population
The study population consisted of 63 consecutive patients (63 lesions) with stable angina who were referred for coronary angiography and were found to have intermediate coronary lesions (40% to 70% DS by angiographic visual assessment). All patients underwent physiological lesion assessment by IC pressure measurements and FFR determination. Exclusion criteria included unstable angina, left ventricular ejection fraction below 40%, significant left main disease (stenosis >50%); multiple lesions
Results
The study patients (n = 63) were mostly men (71%), with a mean (±SD) age of 62 ± 13 (range 45-83) years. The demographic and clinical characteristics of the patients are outlined in Table I. The baseline angiographic and physiological characteristics of the assessed lesions are outlined in Table II. The assessed vessel was the left anterior descending in 32 (51%) of the lesions, left circumflex in 14 (22%) of the lesions, RCA in 14 (22%) of the lesions, and vein graft in 3 (5%) of the lesions.
Discussion
The current study demonstrates that LL may differentially affect the relationship between the anatomic and physiological parameters that describe coronary stenosis severity. Our results may explain the previously observed lack of correlation between angiographic and physiological coronary lesion severity. A categorized cutoff LL value of 10 mm was identified as a sensitive predicting index for a categorized cutoff FFR value of 0.75. By dividing the lesions into 2 subgroups above and below the
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Cited by (59)
Optimization of FFR prediction algorithm for gray zone by hemodynamic features with synthetic model and biometric data
2022, Computer Methods and Programs in BiomedicineCitation Excerpt :For example, if the cross-sectional area of the coronary artery is drastically narrowed, the FFR on that segment could decrease rapidly. And the lesion length could also affect the flow characteristics [18–20]. In this study, morphological features were extracted for predicting FFR.
Frequency of abnormal fractional flow reserve measurements among major coronary arteries
2019, Cardiovascular Revascularization MedicineClinical and angiographic predictors of persistently ischemic fractional flow reserve after percutaneous revascularization
2017, American Heart JournalCitation Excerpt :The distal IC pressure is dependent on the loss of the pressure gradient across the lesion which, according to Poiseuilles law, is inversely related to the lesion length. This inverse correlation between FFR and lesion length in intermediate stenosis has been shown in various studies.18-21 Diffuse disease involving long segments of vessel (>20 mm) can lead to gradual pressure loss over this length and produce a low FFR despite relatively mild angiographic stenosis.
Use of fractional flow reserve in patients with coronary artery disease: The right choice for the right outcome
2017, Trends in Cardiovascular MedicineCitation Excerpt :For instance, lesion length is an important predictor with an inverse correlation with FFR. Accordingly, short lesions can appear angiographically very significant but remain hemodynamically very insignificant whereas lesions >10–20 mm in length are more likely to be functionally relevant even if angiographically not dominant [26,27]. In addition to large plaque burden, plaque rupture is another important predictor for an abnormal FFR in the presence of a benign angiographic appearance [25].
Correlation Between Quantitative Angiography–Derived Translesional Pressure and Fractional Flow Reserve
2016, American Journal of CardiologyA novel coronary angiography index (DILEMMA score) for prediction of functionally significant coronary artery stenoses assessed by fractional flow reserve: A novel coronary angiography index
2015, American Heart JournalCitation Excerpt :To date, only few studies have focused on coronary stenosis lesion length as a predictor of significant FFR. Brosh et al18 demonstrated that lesion length in 63 angiographically determined intermediate lesions had a weak inverse correlation with FFR (r = −0.31). This is comparable with our study finding, which confirmed only moderate inverse correlation (r = −0.48) with FFR.