Key result
Different geometrical shapes of coronary stenosis resulted in varying FFR cut-offs of 0.75, occurring at 76.5% area stenosis for trapezium, 79.5% for elliptical, and 82.7% for triangular models.
Why the study?
Does the geometrical shape of a coronary stenosis affect diagnostic parameters such as FFR in computational models?
Does the geometrical shape of a coronary stenosis affect diagnostic parameters such as FFR in computational models?
Computational modeling demonstrates that the geometric shape of a coronary stenosis significantly influences FFR, potentially causing misinterpretation of lesion severity between 76.5% and 82.7% area stenosis.
Stenosis geometry may confound FFR thresholds between 76-83% area stenosis; hypothesis-generating for shape-adjusted models requiring clinical validation.
The present study deals with the functional severity of a coronary artery stenosis assessed by the fractional flow reserve (FFR). The effects of different geometrical shapes of lesion on the diagnostic parameters are unknown. In this study, 3D computational simulation of blood flow in three different geometrical shapes of stenosis (triangular, elliptical, and trapezium) is considered in steady and transient conditions for 70% (moderate), 80% (intermediate), and 90% (severe) area stenosis (AS). For a given percentage AS, the variation of diagnostic parameters which are derived from pressure drop across the stenosis was found in three different geometrical shapes of stenosis and it was observed that FFR is higher in triangular shape and lower in trapezium shape. The pressure drop coefficient (CDP) was higher in trapezium shape and lower in triangular model whereas the LFC shows opposite trend. From the clinical perspective, the relationship between percentage AS and FFR is linear and inversely related in all the three models. A cut-off value of 0.75 for FFR was observed at 76.5% AS in trapezium model, 79.5% in elliptical model, and 82.7% AS for the triangular shaped model. The misinterpretation of the functional severity of the stenosis is in the region of 76.5%-82.7 % AS from different shapes of stenosis models.
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Kamangar et al. (2014) studied Coronary artery stenosis. Stenosis geometry (triangular, elliptical, trapezium) was evaluated on Fractional flow reserve (FFR). Different geometrical shapes of coronary stenosis resulted in varying FFR cut-offs of 0.75, occurring at 76.5% area stenosis for trapezium, 79.5% for elliptical, and 82.7% for triangular models.
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