Juan Luis Gutiérrez-Chico1,2,3, Carlos Cortés4,5, Miłosz Jaguszewski4,6,7, Michele Schincariol6, Ignacio J Amat-Santos5, Juan A Franco-Peláez8, Grzegorz Żuk7, Dariusz Ciećwierz7, Wojciech Wojakowski9, Felipe Navarro8,10, Shengxian Tu11, Borja Ibáñez8,10,12. 1. Klinikum Frankfurt (Oder), Interventional Cardiology, Germany. juanluis.gutierrezchico@ictra.es. 2. Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany. juanluis.gutierrezchico@ictra.es. 3. DRK-Klinikum Westend, Berlin, Germany. juanluis.gutierrezchico@ictra.es. 4. Klinikum Frankfurt (Oder), Interventional Cardiology, Germany. 5. CIBERCV Hospital Clínico Universitario de Valladolid, ICICOR, Spain. 6. Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany. 7. First Department of Cardiology, Medical University of Gdansk, Poland. 8. IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain. 9. University of Katowice, Poland. 10. CIBERCV, Madrid, Spain. 11. Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. 12. Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
Abstract
BACKGROUND: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen-tial coronary stenosis without balloon inflation is hereby proposed. METHODS: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu-la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls' formula. FFR of the remaining lesion was finally recorded (measured FFR). RESULTS: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls' formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640-0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. CONCLUSIONS: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.
BACKGROUND: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen-tial coronary stenosis without balloon inflation is hereby proposed. METHODS: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu-la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls' formula. FFR of the remaining lesion was finally recorded (measured FFR). RESULTS: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls' formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640-0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. CONCLUSIONS: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.
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