Role of variability in microvascular resistance on fractional flow reserve and coronary blood flow velocity reserve in intermediate coronary lesions.
BACKGROUND
Fractional flow reserve (FFR) and coronary blood flow velocity reserve (CFR) represent physiological quantities used to evaluate coronary lesion severity and to make clinical decisions. A comparison between the outcomes of both diagnostic techniques has not been performed in a large cohort of patients with intermediate coronary lesions.


RESULTS
FFR and CFR were assessed in 126 consecutive patients with 150 intermediate coronary lesions (between 40% and 70% diameter stenosis by visual assessment). Agreement between outcomes of FFR and CFR, categorized at cut-off values of 0.75 and 2.0, respectively, was observed in 109 coronary lesions (73%), whereas discordant outcomes were present in 41 lesions (27%). In 26 of these 41 lesions, FFR was <0.75 and CFR>or=2.0 (group A); in the remaining 15 lesions, FFR was >or=0.75 and CFR<2.0 (group B). Minimum microvascular resistance, defined as the ratio of mean distal pressure to average peak blood flow velocity during maximum hyperemia, showed a large variability (overall range, 0.65 to 4.64 mm Hg x cm(-1) x s(-1)) and was significantly higher in group B than in group A (2.42+/-0.77 versus 1.91+/-0.70 mm Hg x cm(-1) x s(-1); P:=0.034).


CONCLUSIONS
Our findings demonstrate the prominent role of microvascular resistance in modulating the relationship between FFR and CFR and emphasize the importance of combined pressure and flow velocity measurements to evaluate coronary lesion severity and microvascular involvement.
Meuwissen
M
M
Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.meuwissen@amc.uva.nl
Chamuleau
S A
SA
Siebes
M
M
Schotborgh
C E
CE
Koch
K T
KT
de Winter
R J
RJ
Bax
M
M
de Jong
A
A
Spaan
J A
JA
Piek
J J
JJ
D000787:Angina Pectoris / Q000209:etiology; D001783:Blood Flow Velocity; D006328:Cardiac Catheterization; D015331:Cohort Studies; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D008833:Microcirculation; D018084:Ultrasonography, Interventional; D014655:Vascular Resistance