Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pullback pressure gradients. Issue 5 (15th July 2021)

• Record Type: Journal Article
• Authors: Candreva, Alessandro; Mizukami, Takuya; Sonck, Jeroen; Munhoz, Daniel; Nagumo, Sakura; Di Gioia, Giuseppe; Gallinoro, Emanuele; Mileva, Niya; Bartunek, Jozef; Wyffels, Eric; Barbato, Emanuele; De Bruyne, Bernard; Perera, Divaka; Collet, Carlos
• Is Part Of: Catheterization and cardiovascular interventions. Volume 98:Issue 5(2021)
• Page Start: E647
• Page End: E654
• Publication Date: 2021-07-15
• Subjects: coronary artery disease -- coronary physiology -- fractional flow reserve -- pressure drops; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.29868
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: 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.