Visual-functional mismatch between coronary angiography and fractional flow reserve

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Medical imaging

Background:

• Coronary angiography's assessment of lesion severity often lacks correlation with physiological significance.
• The underlying mechanisms of this visual-functional discordance in coronary lesions are not well understood.

Purpose of the Study:

• To identify clinical and lesion-specific factors contributing to the mismatch between visual assessment of coronary lesions by angiography and their physiological significance measured by fractional flow reserve (FFR).

Main Methods:

• A prospective cohort study involving 1,000 patients and 1,129 coronary lesions.
• Quantitative coronary angiography, intravascular ultrasound (IVUS), and FFR were assessed.
• Three-dimensional computational simulations were employed to analyze factors influencing FFR.

Main Results:

• High frequencies of mismatch (angiographic diameter stenosis ≥50% and FFR >0.80) and reverse mismatch (DS <50% and FFR <0.80) were observed.
• Predictors for mismatch included advanced age, non-LAD location, absence of plaque rupture, and lesion morphology.
• Reverse mismatch was associated with younger age, LAD location, plaque rupture, and plaque burden.

Conclusions:

• Significant visual-functional mismatch exists between coronary angiography and FFR.
• Angiography alone is insufficient for accurately predicting FFR due to un recognized clinical and lesion-specific factors.
• These findings underscore the need for physiological assessment beyond visual interpretation of coronary angiograms.