title: Impact of myocardial supply area on the transstenotic hemodynamics as determined by fractional flow reserve.
abstract: OBJECTIVE
  The aim of this study was to investigate the impact of myocardial area supplied by the coronary artery on fractional flow reserve (FFR).
  
  
  BACKGROUND
  Various factors other than the degree of epicardial stenosis influence the physiological significance of a coronary artery stenosis.
  
  
  METHODS
  A total of 296 coronary lesions in 217 patients were analyzed by quantitative coronary angiography and FFR. Myocardial area supplied by the coronary artery distal to the stenosis was evaluated by angiography using a modified version of the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score.
  
  
  RESULTS
  Percent diameter stenosis of the coronary lesion was 57 ± 15% (mean ± standard deviation). FFR <0.80 was seen in 132 (45%) lesions. FFR was significantly correlated with minimum lumen diameter (r = 0.584, P <0.001), percent diameter stenosis (r = -0.565, P <0.001), lesion length (r = -0.306, P <0.001), and myocardial supply area (r = -0.504, P <0.001). Multivariate logistic analysis demonstrated that minimum lumen diameter (odds ratio [OR] = 0.031, 95% confidence interval [CI] = 0.013-0.076, P < 0.001), lesion length (OR = 1.038, 95% CI = 1.009-1.069, P = 0.001), and myocardial supply area (OR = 1.113, 95% CI = 1.079-1.147, P <0.001) were independent determinants for FFR <0.80.
  
  
  CONCLUSIONS
  FFR, which is the index of physiological significance of coronary artery stenosis, is influenced by myocardial supply area distal to the stenosis as well as by its own minimal lumen diameter and lesion length.
authors.affiliation: Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Shiono
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Hironori
authors.initials: H
authors.lastname: Kitabata
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ino
authors.forename: Takashi
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Teruaki
authors.initials: T
authors.lastname: Wada
authors.forename: Shingo
authors.initials: S
authors.lastname: Ota
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ozaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Orii
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Shimamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Ishibashi
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamano
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Hirata
authors.forename: Toshio
authors.initials: T
authors.lastname: Imanishi
authors.forename: Takashi
authors.initials: T
authors.lastname: Akasaka
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003331:Coronary Vessels / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: coronary angiography; fractional flow reserve; ischemic heart disease