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A Poiseuille-based coronary angiographic index for prediction of fractional flow reserve.
MedLine Citation:
PMID:  22360946     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Coronary revascularization is commonly based on the angiographic finding of percent diameter stenosis (%DS) >50 while lesion length (LL), which contributes to flow-limitation according to Poiseuille's equation, is disregarded. Fractional flow reserve (FFR) is superior to assessment of %DS for identifying flow-limiting lesions, but the technology is invasive and relatively expensive. We developed a Poiseuille-based angiographic index, incorporating both minimal lumen diameter (MLD) and LL, for improved assessment of the hemodynamic significance of intermediate coronary lesions. The present study was designed to test the hypothesis that the Poiseuille-based angiographic index correlated better with FFR measurements than angiographic assessment of %DS. METHODS: We performed quantitative coronary angiography (QCA) and FFR measurements in 46 intermediate coronary lesions in 41 symptomatic patients referred for diagnostic coronary angiography. From QCA we determined LL, MLD and %DS and calculated an angiographic index, the LL/MLD(4) ratio. RESULTS: Mean LL was 14.2±7.8 (range: 4.3-38.8) mm, MLD 1.4±0.4 (range: 0.6-2.3) mm, %DS 46±12 (range: 25-74) and FFR 0.85±0.09 (range: 0.55-1.00). Fractional flow reserve correlated inversely with %DS (R=-0.39, p=0.008) and with the LL/MLD(4) ratio (R=-0.66, p<0.0001). An FFR cut-off value of 0.80 corresponded with a LL/MLD(4) ratio of 12 (p=0.003) but not with a %DS of 50 (p=NS). A LL/MLD(4) ratio ≤12 had a specificity of 94% and negative predictive value of 82% for excluding hemodynamically significant lesions with FFR (≥0.80). CONCLUSIONS: The LL/MLD(4) ratio was superior to standard angiographic measurement of %DS for exclusion of hemodynamically significant coronary lesions.
Authors:
Ronen Jaffe; David A Halon; Ariel Roguin; Ronen Rubinshtein; Basil S Lewis
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-2-21
Journal Detail:
Title:  International journal of cardiology     Volume:  -     ISSN:  1874-1754     ISO Abbreviation:  -     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-2-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Ireland Ltd.
Affiliation:
Department of Cardiology at the Lady Davis Carmel Medical Center, the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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