Key result
The pressure drop coefficient allowed better delineation of coronary stenosis severities irrespective of diameter and vascular condition, whereas FFR underestimated severity in MI by up to ~30%.
Why the study?
Does arterial diameter and vascular condition (MI vs no MI) influence the diagnostic parameters FFR and CDP in simulated coronary stenosis?
Does arterial diameter and vascular condition (MI vs no MI) influence the diagnostic parameters FFR and CDP in simulated coronary stenosis?
In an in vitro model, FFR underestimated stenosis severity in the presence of myocardial infarction, whereas the pressure drop coefficient (CDP) allowed better delineation of stenosis severity regardless of diameter and vascular condition.
In current practice, diagnostic parameters, such as fractional flow reserve (FFR) and coronary flow reserve (CFR), are used to determine the severity of a coronary artery stenosis. FFR is defined as the ratio of hyperemic pressures distal (p(rh)) and proximal (p(ah)) to a stenosis. CFR is the ratio of flow at hyperemic and basal condition. Another diagnostic parameter suggested by our group is the pressure drop coefficient (CDP). CDP is defined as the ratio of the pressure drop across the stenosis to the upstream dynamic pressure. These parameters are evaluated by invasively measuring flow (CFR), pressure (FFR), or both (CDP) in a diseased artery using guidewire tipped with a sensor. Pathologic state of artery is indicated by lower CFR (<2). Similarly, FFR lower than 0.75 leads to clinical intervention. Cutoff for CDP is under investigation. Diameter and vascular condition influence both flow and pressure drop, and thus, their effect on FFR and CDP was studied. In vitro experiment coupled with pressure-flow relationships from human clinical data was used to simulate pathophysiologic conditions in two representative arterial diameters, 2.5 mm (N1) and 3 mm (N2). With a 0.014 in. (0.35 mm) guidewire inserted, diagnostic parameters were evaluated for mild (∼64% area stenosis (AS)), intermediate (∼80% AS), and severe (∼90% AS) stenosis for both N1 and N2 arteries, and between two conditions, with and without myocardial infarction (MI). Arterial diameter did not influence FFR for clinically relevant cases of mild and intermediate stenosis (difference < 5%). Stenosis severity was underestimated due to higher FFR (mild: ∼9%, intermediate: ∼ 20%, severe: ∼ 30%) for MI condition because of lower pressure drops, and this may affect clinical decision making. CDP varied with diameter (mild: ∼20%, intermediate: ∼24%, severe: by 2.5 times), and vascular condition (mild: ∼35%, intermediate: ∼14%, severe: ∼ 9%). However, nonoverlapping range of CDP allowed better delineation of stenosis severities irrespective of diameter and vascular condition.
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Goswami et al. (2013) studied Coronary artery stenosis. Pressure drop coefficient (CDP) and fractional flow reserve (FFR) vs. Different arterial diameters and vascular conditions (with and without MI) was evaluated on Influence of arterial diameter and vascular condition on FFR and CDP. The pressure drop coefficient allowed better delineation of coronary stenosis severities irrespective of diameter and vascular condition, whereas FFR underestimated severity in MI by up to ~30%.
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