Related Experiment Video
Updated: Jul 4, 2026
Increasing Pulmonary Artery Pulsatile Flow Improves Hypoxic Pulmonary Hypertension in Piglets
Published on: May 11, 2015
Evaluation of Pulmonary Artery Flow Reserve in Patients With Chronic Thromboembolic Pulmonary Hypertension: A Pilot
Jinzhi Wang1,2,3, Linfeng Xi2,3, Xincao Tao4
1China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College Beijing China.
Background:
Pressure-wire fractional flow reserve (FFR) can guide balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension, but lesion crossing with a distal wire increases cost and procedural risk. We developed an angiography-derived physiologic index-pulmonary artery flow reserve (PFR)-computed from selective pulmonary angiography using fluid-dynamic modeling without distal pressure-wire advancement.
Methods:
In this prospective observational study, selective pulmonary angiography was acquired in 2 projections for type A (ring-like), type B (web lesion) and type C (subtotal) pulmonary artery lesions. Proximal pressure (Pa) was measured at the target vessel ostium using a pressure-sensor catheter; flow velocity was estimated by frame counting; pressure drop (ΔP) was computed by a proprietary computational fluid dynamics approach, and PFR was derived as (Pa - ΔP)/Pa. Pressure-wire FFR (Pd/Pa) served as the reference standard (FFR ≤0.80). Diagnostic performance was assessed by receiver operating characteristic analysis and agreement by Bland-Altman analysis.
Results:
Fifty-two vessels in 29 patients were analyzed. Mean FFR and PFR were 0.57 ± 0.23 and 0.58 ± 0.24; 44 vessels had FFR ≤0.80. PFR showed excellent discrimination for FFR ≤0.80 (area under the curve 0.981, 95% CI 0.935-1.000), with sensitivity 94.1% (95% CI 80.9%-98.7%) and specificity 87.5% (95% CI 64.0%-97.0%) at an optimal PFR cutoff of 0.77. Agreement was high (bias 0.0076; 95% limits of agreement -0.1037 to 0.1190), and correlation was strong (r=0.970, P<0.001). At 3-month follow-up (n=45 vessels), PFR maintained high performance (area under the curve 0.985; bias 0.0071; r=0.967; all P<0.001).
Conclusions:
Angiography-derived PFR demonstrated strong agreement with pressure-wire FFR for physiologic assessment of pulmonary artery stenoses in chronic thromboembolic pulmonary hypertension and may provide a simpler alternative to distal pressure-wire measurements to support physiology-guided balloon pulmonary angioplasty.
