Correlations between Fractional Flow Reserve and Coronary Artery Stenosis Based on the Stenosis Position and Coronary Dominant Type_Journal of Biomedical Engineering

Authors：

YANGQingqing ¹ ,  QIAOAike ¹ , HOUYang ² , MAYue ²

1. College of Life Science and Bioengineering, Beijing University of Technology, Beijing 100124, China;
2. Shengjing Hospital of China Medical University, Shenyang 110001, China;

Corresponding author：

QIAOAike, Email: qak@bjut.edu.cn

Keywords：

coronary artery stenosis; correlation analysis; myocardial ischemia; fractional flow reserve

DOI：

10.7507/1001-5515.20160151

Video：

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Abstract Full text Figures/Tables Video References Cited by

For coronary artery diseases, imaging diagnosis is usually used to guide the treatment. However, it can only reflect the geometric characteristics of the disease but does not determine the hemodynamically significant stenosis. This study was aimed to investigate the relationship between angiographic and functional severity of coronary artery stenosis and to improve the diagnostic value of imaging. 39 patients with 55 stenosis vessels were included in this study. The correlation between FFR and stenosis rate was analyzed with the medical statistical analysis method, and the influence of the position of stenosis and coronary dominant type on the correlation was discussed. By regression analysis, the stenosis rate of left anterior descending artery of right dominant type showed a significant correlation with FFR value (r≈0.79, P < 0.000 1) after grouping with position and the dominant type. Due to the significance of a value of the FFR < 0.80 in determining inducible ischemia, the diagnostic accuracy of myocardial ischemia by the stenosis rate increased from 70.9% to 82.8% after grouping. Sensitivity (from 72.2% to 78.6%) and specificity (from 70.3% to 86.7%) were also significantly improved. This study indicates that the position of stenosis and the coronary dominant type are significant influence factors on the correlation between FFR and stenosis rate. Consideration of these two factors in the diagnosis of myocardial ischemia by imaging will be helpful to improve the effectiveness of diagnosis.

Citation： YANG Qingqing, QIAO Aike, HOU Yang, MA Yue. Correlations between Fractional Flow Reserve and Coronary Artery Stenosis Based on the Stenosis Position and Coronary Dominant Type. Journal of Biomedical Engineering, 2016, 33(5): 939-944. doi: 10.7507/1001-5515.20160151 Copy

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11.	DORBALA S, BLANKSTEIN R, SKALI H, et al. Approaches to reducing radiation dose from radionuclide myocardial perfusion imaging[J]. J Nucl Med, 2015, 56(4):592-599.
12.	KLEIMAN N S. Bringing it all together integration of physiology with anatomy during cardiac catheterization[J]. J Am Coll Cardiol, 2011, 58(12):1219-1221.
13.	MEIJBOOM W B, VAN MIEGHEM C A, VAN PELT N, et al. Comprehensive assessment of coronary artery stenoses:computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina[J]. J Am Coll Cardiol, 2008, 52(8):636-643.
14.	TONINO P A, FEARON W F, DE BRUYNE B A, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation[J]. J Am Coll Cardiol, 2010, 55(25):2816-2821.
15.	TAKAGI A, TSURUMI Y, ISHⅡ Y, et al. Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis:relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve[J]. Circulation, 1999, 100(3):250-255.
16.	JASTI V, IVAN E, YALAMANCHILI V, et al. Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis[J]. Circulation, 2004, 110(18):2831-2836.
17.	CHAMULEAU S J, MARTIJN M, KOCH K T, et al. Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis[J]. Am J Cardiol, 2002, 89(4):377-380.
18.	SERRUYS P W, ONUMA Y, GARG S, et al. Assessment of the SYNTAX score in the Syntax study[J]. EuroIntervention, 2009, 5(1):50-56.
19.	CHAKRAVARTY T, BUCH M H, NAIK H, et al. Predictive accuracy of SYNTAX score for predicting Long-Term outcomes of unprotected left main coronary artery revascularization[J]. Am J Cardiol, 2011, 107(3):360-366.
20.	NAM C W, MANGIACAPRA F, ENTJES R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease[J]. J Am Coll Cardiol, 2011, 58(12):1211-1218.
21.	YEW K L. The role of fractional flow reserve in pre-operative coronary angiography in redefining functional syntax score and cardiac risk in multivessel coronary artery disease[J]. Int J Cardiol, 2014, 177(3):E163-E164.
22.	KOBAYASHI Y, NAM C W, TONINO P A, et al. TCT-37 the prognostic value of the residual SYNTAX score after "functionally" complete revascularization:insights from the FAME(fractional flow reserve versus angiography for multivessel evaluation)trial[J]. J Am Coll Cardiol, 2015, 66(15):1-14.
23.	萨建, 刘桂芬.定量测量结果的一致性评价及Bland-Altman法的应用[J].中国卫生统计, 2011, 28(4):409-411, 413.

1. KERL J M, HOFMANN L K, THILO C, et al. Coronary CTA-image acquisition and interpretation[J]. J Thorac Imaging, 2007, 22(1):22-34.
2. MAZHAR J, SHAW E, ALLAHWALA U K, et al. Comparison of two dimensional quantitative coronary angiography(2D-QCA)with optical coherence tomography(OCT)in the assessment of coronary artery lesion dimensions[J]. IJC Heart & Vasculature, 2015, 101(9):14-17.
3. PANAICH S S, ARORA S, PATEL N, et al. Intravascular ultrasound in lower extremity peripheral vascular interventions:variation in utilization and impact on In-Hospital outcomes from the nationwide inpatient sample (2006-2011)[J]. Lancet, 2016, 23(1):65-75.
4. DUVALL W L, RAI M, AHLBERG A W, et al. A multi-center assessment of the temporal trends in myocardial perfusion imaging[J]. J Nucl Cardiol, 2015, 22:1-13.
5. PIJLS N J, BRUYNE B D, PEELS K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses[J]. N Engl J Med, 1996, 334(26):1703-1708.
6. PIJLS N J, SELS J M. Functional measurement of coronary stenosis[J]. J Am Coll Cardiol, 2012, 59(12):1045-1057.
7. PIJLS N H, TANAKA N, FEARON W F. Functional assessment of coronary stenoses:can we live without it?[J]. Eur Heart J, 2013, 34(18):1335-1344.
8. PIJLS N J. Fractional flow reserve to guide coronary revascularization[J]. Circ J, 2013, 77(3):561-569.
9. PIJLS N J, FEARON W F, TONINO P L, et al. Fractional FlowReserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease 2-Year Follow-Up of the FAME(fractional flow reserve versus angiography for multivessel evaluation)study[J]. J Am Coll Cardiol, 2010, 56(3):177-184.
10. PIJLS N H, VAN SCHAARDENBURGH P, MANOHARAN G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis-5-year follow-up of the DEFER study[J]. J Am Coll Cardiol, 2007, 49(21):2105-2111.
11. DORBALA S, BLANKSTEIN R, SKALI H, et al. Approaches to reducing radiation dose from radionuclide myocardial perfusion imaging[J]. J Nucl Med, 2015, 56(4):592-599.
12. KLEIMAN N S. Bringing it all together integration of physiology with anatomy during cardiac catheterization[J]. J Am Coll Cardiol, 2011, 58(12):1219-1221.
13. MEIJBOOM W B, VAN MIEGHEM C A, VAN PELT N, et al. Comprehensive assessment of coronary artery stenoses:computed tomography coronary angiography versus conventional coronary angiography and correlation with fractional flow reserve in patients with stable angina[J]. J Am Coll Cardiol, 2008, 52(8):636-643.
14. TONINO P A, FEARON W F, DE BRUYNE B A, et al. Angiographic versus functional severity of coronary artery stenoses in the FAME study fractional flow reserve versus angiography in multivessel evaluation[J]. J Am Coll Cardiol, 2010, 55(25):2816-2821.
15. TAKAGI A, TSURUMI Y, ISHⅡ Y, et al. Clinical potential of intravascular ultrasound for physiological assessment of coronary stenosis:relationship between quantitative ultrasound tomography and pressure-derived fractional flow reserve[J]. Circulation, 1999, 100(3):250-255.
16. JASTI V, IVAN E, YALAMANCHILI V, et al. Correlations between fractional flow reserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis[J]. Circulation, 2004, 110(18):2831-2836.
17. CHAMULEAU S J, MARTIJN M, KOCH K T, et al. Usefulness of fractional flow reserve for risk stratification of patients with multivessel coronary artery disease and an intermediate stenosis[J]. Am J Cardiol, 2002, 89(4):377-380.
18. SERRUYS P W, ONUMA Y, GARG S, et al. Assessment of the SYNTAX score in the Syntax study[J]. EuroIntervention, 2009, 5(1):50-56.
19. CHAKRAVARTY T, BUCH M H, NAIK H, et al. Predictive accuracy of SYNTAX score for predicting Long-Term outcomes of unprotected left main coronary artery revascularization[J]. Am J Cardiol, 2011, 107(3):360-366.
20. NAM C W, MANGIACAPRA F, ENTJES R, et al. Functional SYNTAX score for risk assessment in multivessel coronary artery disease[J]. J Am Coll Cardiol, 2011, 58(12):1211-1218.
21. YEW K L. The role of fractional flow reserve in pre-operative coronary angiography in redefining functional syntax score and cardiac risk in multivessel coronary artery disease[J]. Int J Cardiol, 2014, 177(3):E163-E164.
22. KOBAYASHI Y, NAM C W, TONINO P A, et al. TCT-37 the prognostic value of the residual SYNTAX score after "functionally" complete revascularization:insights from the FAME(fractional flow reserve versus angiography for multivessel evaluation)trial[J]. J Am Coll Cardiol, 2015, 66(15):1-14.
23. 萨建, 刘桂芬.定量测量结果的一致性评价及Bland-Altman法的应用[J].中国卫生统计, 2011, 28(4):409-411, 413.

Journal of Biomedical Engineering

Correlations between Fractional Flow Reserve and Coronary Artery Stenosis Based on the Stenosis Position and Coronary Dominant Type

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