Do-Yoon Kang1, Jung-Min Ahn1, Young Woo Kim2, Ji Young Moon3, Joon Sang Lee2, Bon-Kwon Koo4, Pil Hyung Lee1, Duk-Woo Park1, Soo-Jin Kang1, Seung-Whan Lee1, Young-Hak Kim1, Seong-Wook Park1, Seung-Jung Park1. 1. Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea (D.-Y.K., J.-M.A., P.H.L., D.-W.P., S.-J.K., S.-W.L., Y.-H.K., S.-W.P., S.-J.P.). 2. School of Mechanical Engineering, Yonsei University, Seoul, South Korea (Y.W.K., J.S.L.). 3. School of Aerospace, Mechanical, and Mechatronic Engineering, The University of Sydney, Australia (J.Y.M.). 4. Department of Internal Medicine and the Cardiovascular Center, Seoul National University Hospital, South Korea (B.-K.K.).
Abstract
BACKGROUND: The impact of various coronary lesion geometries on fractional flow reserve (FFR) is poorly understood. METHODS AND RESULTS: A total of 1552 coronary lesions in 1236 patients from a prospective Interventional Cardiology Research In-cooperation Society Fractional Flow Reserve and Intravascular Ultrasound registry were assessed using quantitative coronary angiography, intravascular ultrasound, and FFR. Computational fluid dynamics simulation was performed for theoretical validation. Patients with complex geometries, such as longitudinal eccentricity, cross-sectional eccentricity, and surface roughness, showed significantly lower FFR values. In multivariable analysis, distal longitudinal eccentricity (adjusted odds ratio, 1.55; 95% confidence interval, 1.04-2.87; P=0.031), cross-sectional eccentricity (adjusted odds ratio, 1.65; 95% confidence interval, 1.27-2.14; P<0.001), and surface roughness (adjusted odds ratio, 1.55; 95% confidence interval, 1.04-2.32; P=0.033), as well as male sex, left anterior descending artery territory, proximal location, high degree of diameter stenosis, long lesion, and high plaque burden, were identified as independent predictors for significantly low FFR values (≤0.80). Computational simulation supported the impact of lesion geometry on FFR. CONCLUSIONS: The complex coronary lesion geometries were independently associated with reduced FFR values. The visual-functional mismatch between coronary angiography and FFR could be partly attributable to local geometric factors. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01366404.
BACKGROUND: The impact of various coronary lesion geometries on fractional flow reserve (FFR) is poorly understood. METHODS AND RESULTS: A total of 1552 coronary lesions in 1236 patients from a prospective Interventional Cardiology Research In-cooperation Society Fractional Flow Reserve and Intravascular Ultrasound registry were assessed using quantitative coronary angiography, intravascular ultrasound, and FFR. Computational fluid dynamics simulation was performed for theoretical validation. Patients with complex geometries, such as longitudinal eccentricity, cross-sectional eccentricity, and surface roughness, showed significantly lower FFR values. In multivariable analysis, distal longitudinal eccentricity (adjusted odds ratio, 1.55; 95% confidence interval, 1.04-2.87; P=0.031), cross-sectional eccentricity (adjusted odds ratio, 1.65; 95% confidence interval, 1.27-2.14; P<0.001), and surface roughness (adjusted odds ratio, 1.55; 95% confidence interval, 1.04-2.32; P=0.033), as well as male sex, left anterior descending artery territory, proximal location, high degree of diameter stenosis, long lesion, and high plaque burden, were identified as independent predictors for significantly low FFR values (≤0.80). Computational simulation supported the impact of lesion geometry on FFR. CONCLUSIONS: The complex coronary lesion geometries were independently associated with reduced FFR values. The visual-functional mismatch between coronary angiography and FFR could be partly attributable to local geometric factors. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01366404.
Authors: Madhurima Vardhan; John Gounley; S James Chen; Eric C Chi; Andrew M Kahn; Jane A Leopold; Amanda Randles Journal: Sci Rep Date: 2021-04-14 Impact factor: 4.379