title: Influence of the amount of myocardium subtended by a stenosis on fractional flow reserve.
abstract: BACKGROUND
  Fractional flow reserve (FFR) specifically relates to the severity of a stenosis to the mass of tissue to be perfused. Accordingly, the larger the territory to be perfused, the greater the flow and the pressure gradient induced by maximal hyperemia. Although this notion may be considered intuitive, its unequivocal demonstration is still lacking. The aim of our study was to evaluate the influence of the amount of myocardium subtended to an intermediate stenosis on FFR, especially in relation to quantitative coronary angiography.
  
  
  RESULTS
  The severity of each lesion was assessed by FFR and 2-dimensional quantitative coronary angiography. The amount of jeopardized myocardium was evaluated using 3 validated scores specifically adapted to this aim: the Duke Jeopardy Score (DJS), the Myocardial Jeopardy Index (MJI), and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) Lesion Score (ALS). The presence of a concomitant collateralized chronic total occlusion was also reported. A total of 213 intermediate coronary stenoses in 184 patients were enrolled. FFR values were correlated to minimal lumen diameter (r=0.34; P<0.0001) and diameter stenosis (r=-0.28; P<0.0001). FFR was inversely correlated with DJS, MJI, and ALS (r=-0.28, P<0.0001; r=-0.40, P<0.0001; and r=-0.34, P<0.0001). Lesions localized on proximal left anterior descending were related to significantly lower FFR values and to a higher rate of a positive FFR compared with those in distal left anterior descending, left circumflex, and right coronary arteries (0.80±0.09 versus 0.84±0.08 versus 0.88±0.09 versus 0.91±0.04; P<0.0001). The presence of a collateralized chronic total occlusion was associated with significantly lower FFR values (0.80±0.07 versus 0.85±0.09; P<0.005). At multivariate analysis MJI, minimal lumen diameter, and presence of a collateralized chronic total occlusion were confirmed as significant predictors of FFR.
  
  
  CONCLUSIONS
  A larger amount of perfused myocardium subtended by a stenosis is associated with a higher probability that an angiographically intermediate coronary stenosis is functionally significant.
authors: Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, 00168 Rome, Italy. antoniomarialeone@gmail.com
authors: Antonio Maria
authors: AM
authors: Leone
authors: Alberto Ranieri
authors: AR
authors: De Caterina
authors: Eloisa
authors: E
authors: Basile
authors: Andrea
authors: A
authors: Gardi
authors: Domenico
authors: D
authors: Laezza
authors: Mario Attilio
authors: MA
authors: Mazzari
authors: Rocco
authors: R
authors: Mongiardo
authors: Rajesh
authors: R
authors: Kharbanda
authors: Florim
authors: F
authors: Cuculi
authors: Italo
authors: I
authors: Porto
authors: Giampaolo
authors: G
authors: Niccoli
authors: Francesco
authors: F
authors: Burzotta
authors: Carlo
authors: C
authors: Trani
authors: Adrian Paul
authors: AP
authors: Banning
authors: Antonio Giuseppe
authors: AG
authors: Rebuzzi
authors: Filippo
authors: F
authors: Crea
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006334:Heart Function Tests / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000378:metabolism*; D011237:Predictive Value of Tests