Influence of different physiological hemodynamics on fractional flow reserve values in the left coronary artery and right coronary artery

• Published in: Heart and vessels Vol. 36; no. 8; pp. 1125 - 1131
• Main Authors: Wada, Kensaku, Fujii, Kenichi, Horitani, Keita, Kishimoto, Hiroshi, Hashimoto, Kenta, Shibutani, Hiroki, Tsujimoto, Satoshi, Matsumura, Koichiro, Otagaki, Munemitsu, Morishita, Shun, Iwasaki, Masayoshi, Shiojima, Ichiro
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.08.2021; Springer Nature B.V
• Subjects: Aorta; Biomedical Engineering and Bioengineering; Blood flow; Blood pressure; Blood vessels; Cardiac Surgery; Cardiology; Coronary artery; Coronary vessels; Diastole; Diastolic pressure; Flow distribution; Hemodynamics; Hyperemia; Mathematical analysis; Medicine; Medicine & Public Health; Original Article; Pressure drop; Stenosis; Stents; Systole; Systolic pressure; Vascular Surgery; Veins & arteries; Waveforms; Coronary artery disease; Fractional flow reserve; Coronary physiology
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-021-01797-z

Background Although the left coronary artery (LCA) has a flow profile in that most blood flow occurs during diastole rather than systole, the right coronary artery (RCA) has a flow pattern that is less diastolic dominant. This study assessed whether coronary pressure waveforms distal to stenoses with the same fractional flow reserve (FFR) was the same between the LCA and RCA. Methods A total of 347 vessels from 318 patients who underwent FFR measurements were included. Conventional FFR was calculated as the ratio of the mean coronary distal pressure (Pd) to the mean aortic pressure (Pa) at maximal hyperemia. The pressure drop ratios in systole (PDR systole ) and diastole (PDR diastole ) were calculated as the sum of (Pa minus Pd) divided by the sum of Pa at the intracoronary diastolic and systolic pressure phases, respectively. Results Analysis of covariance of the regression line of correlation between conventional FFR and PDR systole revealed that the slope was significantly greater in the RCA than in the left anterior descending artery (LAD) and left circumflex artery (LCX) (−0.765, −0.578, and −0.589, p  < 0.001). On the other hand, the regression line of correlation between conventional FFR and PDR diastole found that the slope was significantly greater in the LAD and LCX than in the RCA (−1.349, −1.318, and −1.223, p  < 0.001). Conclusions The pressure waveform distal to the stenosis differs between the LCA and RCA. In the LCA, the decrease in diastolic pressure mainly contributed to the drop in FFR, whereas in the RCA, it was the decrease in systolic pressure.