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Published on: April 13, 2015
Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pullback pressure gradients
Alessandro Candreva1,2, Takuya Mizukami1,3, Jeroen Sonck1,4
1Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Insights
Fractional flow reserve (FFR) pullbacks reveal distinct hemodynamic patterns in serial coronary lesions. The pullback pressure gradients (PPG) index quantifies disease patterns, aiding in assessing revascularization appropriateness.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Diagnostic imaging
Background:
- Assessing serial coronary stenoses is complex due to inter-lesion hemodynamic crosstalk.
- Predicting the functional significance of individual lesions in multi-stenotic segments remains challenging.
Purpose of the Study:
- To characterize the hemodynamics of serial coronary stenoses using fractional flow reserve (FFR) pullbacks.
- To evaluate the utility of the pullback pressure gradients (PPG) index in assessing coronary artery disease patterns.
Main Methods:
- Prospective recruitment of 117 patients with stable angina undergoing coronary angiography.
- Motorized FFR pullback tracings acquired at 1 mm/s in vessels with ≥2 lesions (visual stenosis >50%).
- Quantification of disease pattern using the PPG index and adjudication of focal pressure drops.
Main Results:
- Twenty-five vessels had serial lesions, with a mean PPG of 0.48 ± 0.17.
- Two, one, or no focal pressure drops were identified in 40%, 52%, and 8% of cases, respectively.
- The PPG index independently predicted the presence of two focal pressure drops (p=0.04).
Conclusions:
- FFR pullbacks demonstrate three distinct functional patterns in serial coronary lesions.
- A high PPG index correlates with pullback curves showing two pressure drops.
- The PPG index offers quantitative assessment of coronary artery disease patterns in serial lesions, potentially guiding revascularization decisions.
Objectives:
To characterize hemodynamics of serial coronary stenoses using fractional flow reserve (FFR) pullbacks and the pullback pressure gradients (PPG) index.
Background:
The cross-talk between stenoses within the same coronary artery makes the prediction of the functional contribution of each lesion challenging.
Methods And Results:
One-hundred seventeen patients undergoing coronary angiography for stable angina were prospectively recruited. Serial lesions were defined as two or more narrowings with visual diameter stenosis >50% on conventional angiography. Motorized FFR pullback tracings were obtained at 1 mm/s. Pullbacks were visually adjudicated as presenting two, one, and no focal pressure drops. The pattern of disease (i.e., focal or diffuse) was quantified using the PPG index. Twenty-five vessels presented serial lesions (mean PPG 0.48 ± 0.17). Two, one or no focal pressure drops were observed in 40% (n = 10; PPG 0.59 ± 0.17), 52% (n = 13; PPG 0.44 ± 0.12) and 8% of cases (n = 2; PPG 0.27 ± 0.01; p-value = 0.01). Distal FFR was similar between vessels with two, one and no focal pressure drops in the pullback curve (p-value = 0.27). The PPG index independently predicted the presence of two focal pressure drops in the pullback curve (p = 0.04).
Conclusions:
FFR pullbacks in serial coronary lesions exhibit three distinct functional patterns. High PPG was associated with pullback curves presenting two pressure drops. The PPG provides a quantitative assessment of the pattern of coronary artery disease in cases with serial lesions and might be useful to assess the appropriateness of percutaneous revascularization.
