Key result
Placing a guidewire during fractional flow reserve measurement in moderate stenosis leads to an overestimation of severity, reducing the FFR value from 0.43 to 0.33 with a 23.26% error compared to the actual flow ratio.
Why the study?
Inserting a guidewire across a stenosis during fractional flow reserve measurement may cause a false overestimation of stenosis severity.
Does guidewire insertion cause false overestimation of severity in fractional flow reserve measurements in coronary artery disease?
Does guidewire insertion cause false overestimation of severity in fractional flow reserve measurements in coronary artery disease?
Placing a guidewire during FFR measurement in moderate to severe coronary stenosis leads to an overestimation of severity due to the physical reduction of the cross-sectional area.
Answers are grounded in this paper and cite their sources.
Guidewire insertion may overestimate moderate stenosis on FFR; leaves open need for clinical validation of wire-free alternatives.
BACKGROUND: Coronary artery disease is an abnormal contraction of the heart supply blood vessel. It limits the oxygenated blood flow to the heart. Thus, diagnosing its severity helps physicians to select the appropriate treatment plan. Fractional flow reserve (FFR) is the most accurate method to pinpoint the stenosis severity. However, inserting the guidewire across stenosis may cause a false overestimation of severity. METHODS: To estimate the errors due to guidewire insertion, reconstructed three-dimensional coronary artery geometry from a patient-specific scan is used. A comprehensive three-dimensional blood flow model is developed. Blood is considered non-Newtonian and the flow is pulsatile. The model is numerically simulated using realistic boundary conditions. RESULTS: The FFR value is calculated and compared with the actual flow ratio. Additionally, the ratio between pressure drop and distal dynamic pressure (CDP) is studied. The obtained results for each case are compared and analyzed with the case without a guidewire. It was found that placing the guidewire leads to overestimating the severity of moderate stenosis. It reduces the FFR value from 0.43 to 0.33 with a 23.26% error compared to 0.44 actual flow ratio and the CDP increases from 5.31 to 7.2 with a 35.6% error. FFR value in mild stenosis does not have a significant change due to placing the guidewire. The FFR value decreases from 0.83 to 0.82 compared to the 0.83 actual flow ratio. CONCLUSION: Consequently, physicians should consider these errors while deciding the treatment plan.
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Abuouf et al. (2021) studied Coronary artery disease (n=1). Guidewire insertion vs. Without guidewire was evaluated on Fractional flow reserve (FFR) value in moderate stenosis (23.26% error). Placing a guidewire during fractional flow reserve measurement in moderate stenosis leads to an overestimation of severity, reducing the FFR value from 0.43 to 0.33 with a 23.26% error compared to the actual flow ratio.
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