Related Experiment Video
Updated: May 11, 2026
Ultrasound Based Assessment of Coronary Artery Flow and Coronary Flow Reserve Using the Pressure Overload Model in Mice
Published on: April 13, 2015
Ventricular-Coronary Interaction Delay is Associated With Discordance Between Fractional Flow Reserve and Coronary
Ahmet Tas1, Yaren Alan2, Alp Ozcan2
1Department of Cardiology, Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands; Emergency Department, Gomec State Hospital, Balikesir, Turkey.
Insights
Preserved coronary flow reserve (CFR) may allow deferring revascularization for lesions with abnormal fractional flow reserve (FFR). Wave intensity analysis (WIA) reveals distinct cardiac-coronary coupling dynamics in discordant FFR-CFR lesions, suggesting good prognosis.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Interventional Cardiology
Background:
- Recent studies suggest preserved coronary flow reserve (CFR) may justify deferring revascularization for lesions with abnormal fractional flow reserve (FFR).
- Understanding the underlying cardiac-coronary coupling dynamics is crucial for optimizing treatment decisions.
- Wave intensity analysis (WIA) offers a novel approach to assess these interactions.
Purpose of the Study:
- To elucidate cardiac-coronary coupling dynamics using WIA in lesions with concordant and discordant FFR-CFR.
- To investigate the relationship between WIA profiles and the magnitude/timing of net coronary wave intensity (WI).
- To identify WIA markers that predict lesion characteristics and potential benefit from revascularization.
Main Methods:
- Utilized WIA in lesions categorized by concordant (normal/abnormal) and discordant FFR-CFR.
- Analyzed the timing of forward compression waves (FCW), backward compression waves (BCW), and backward expansion waves (BEW) relative to ventricular dynamics.
- Correlated WIA parameters (e.g., peak times) with FFR and CFR values.
Main Results:
- Preserved FFR correlated with earlier flow acceleration from ventricular compression/expansion.
- Preserved CFR associated with earlier peaks of microvascular backward traveling waves.
- Concordantly abnormal FFR-CFR lesions showed delayed WI peaks compared to normal lesions.
- Discordant lesions exhibited preserved tBEWpeak despite systolic WI dyssynchrony.
- A resting BEW peak within the first 13% of ventricular expansion predicted a 87% negative predictive value for concordantly abnormal FFR-CFR lesions.
Conclusions:
- Discordantly abnormal FFR or CFR are linked to dyssynchronous ventricular-coronary interactions identified by WIA.
- The preserved timing of the microvascular suction effect (tBEWpeak) in discordant lesions may explain their favorable prognosis without revascularization.
- Delayed tBEWpeak in concordantly abnormal FFR-CFR lesions could serve as a unified marker for identifying lesions that would benefit from revascularization.
Abstract:
Recently, the multicenter DEFINE-FLOW and ILIAS registry studies revealed that a preserved coronary flow reserve (CFR) (≥2.0) may justify the deferral of revascularization for lesions with abnormal fractional flow reserve (FFR) (≤0.8). We used wave intensity analysis (WIA) in lesions with concordant and discordant FFR-CFR to elucidate underlying cardiac-coronary coupling dynamics and how these indices relate to the magnitude and timing of the net coronary WI profile. Preserved FFR is primarily associated with earlier coronary flow-accelerating effect of ventricular compression and expansion (peak times of FCW-BEW: tFCWpeak: r = -0.275 p <0.001, tBEWpeak: r = -0.388 p <0.001) while preserved CFR is associated with earlier peaks of backward travelling waves of microvascular origin, which may be decelerating (tBCWpeakr= -0.281 p <0.001) or accelerating (tBEWpeakr = -0.221 p <0.001). Concordant abnormal FFR-CFR lesions exhibited delayed peaks of FCW, BCW and BEW compared to concordant normal lesions (p <0.001), whereas discordant FFR-CFR lesions had preserved tBEWpeak despite dyssynchrony of systolic WI peaks (relative FCW-BCW peak times: tFCWpeak: 48% ± 22% vs 34% ± 18% p <0.001, tBCWpeak:38% ± 26% vs 51% ± 33% ± of compression period p <0.001). A resting BEW peak within the first 13% of the ventricular expansion phase had a 87% negative predictive value for concordant abnormal FFR-CFR lesions. In conclusion, discordantly abnormal FFR or CFR are associated with dyssynchrony of ventricular-coronary interactions revealed by WIA. The relative time to peak microvascular suction effect, which is responsible for diastolic filling, is preserved in discordant lesions. This is marked by reference level tBEWpeak,similar to that of lesions with concordant normal FFR and CFR, that may explain the good prognosis of discordant lesions without revascularization. In contrast, the concordantly abnormal FFR-CFR group exhibits a substantial delay of tBEWpeak, which may serve as a potential unified marker for lesions that would benefit from revascularization.
Related Concept Videos
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
01:22Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
01:22Mitral Stenosis I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:30Coronary Artery Disease III: Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies