Key result
In a swine model, angiographically measured stem hyperemic flow and associated crown lumen volume were highly correlated (r = 0.98), indicating that lumen volume can predict expected hyperemic flow.
Effect estimate: r = 0.98
Measured arterial branch lengths or lumen volumes from angiographic data can accurately predict expected hyperemic flow, potentially allowing for the calculation of fractional flow reserve without a pressure wire.
Lumen volume may predict hyperemic flow in swine; leaves open validation for wire-free FFR in humans.
The purpose of this study is to develop a method to estimate the hyperemic blood flow in a coronary artery using the sum of the distal lumen volumes in a swine animal model. The limitations of visually assessing coronary artery disease are well known. These limitations are particularly important in intermediate coronary lesions where it is difficult to determine whether a particular lesion is the cause of ischemia. Therefore, a functional measure of stenosis severity is needed using angiographic image data. Coronary arteriography was performed in 10 swine (Yorkshire, 25-35 kg) after power injection of contrast material into the left main coronary artery. A densitometry technique was used to quantify regional flow and lumen volume in vivo after inducing hyperemia. Additionally, 3 swine hearts were casted and imaged post-mortem using cone-beam CT to obtain the lumen volume and the arterial length of corresponding coronary arteries. Using densitometry, the results showed that the stem hyperemic flow (Q) and the associated crown lumen volume (V) were related by Q = 159.08 V(3/4) (r = 0.98, SEE = 10.59 ml/min). The stem hyperemic flow and the associated crown length (L) using cone-beam CT were related by Q = 2.89 L (r = 0.99, SEE = 8.72 ml/min). These results indicate that measured arterial branch lengths or lumen volumes can potentially be used to predict the expected hyperemic flow in an arterial tree. This, in conjunction with measured hyperemic flow in the presence of a stenosis, could be used to predict fractional flow reserve based entirely on angiographic data.
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Molloi et al. (2011) studied Coronary artery disease (functional measure of stenosis severity) (n=10). Angiographic densitometry and cone-beam CT was evaluated on Correlation between stem hyperemic flow and associated crown lumen volume (r = 0.98). In a swine model, angiographically measured stem hyperemic flow and associated crown lumen volume were highly correlated (r = 0.98), indicating that lumen volume can predict expected hyperemic flow.
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