open access

Vol 26, No 4 (2019)
Original articles — Interventional cardiology
Published online: 2019-06-27
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A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study

Juan Luis Gutiérrez-Chico, Carlos Cortés, Miłosz Jaguszewski, Michele Schincariol, Ignacio J. Amat-Santos, Juan A. Franco-Peláez, Grzegorz Żuk, Dariusz Ciećwierz, Wojciech Wojakowski, Felipe Navarro, Shengxian Tu, Borja Ibáñez
DOI: 10.5603/CJ.a2019.0067
·
Pubmed: 31257567
·
Cardiol J 2019;26(4):310-321.

open access

Vol 26, No 4 (2019)
Original articles — Interventional cardiology
Published online: 2019-06-27

Abstract

Background: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen­tial coronary stenosis without balloon inflation is hereby proposed.

Methods: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu­la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls’ formula. FFR of the remaining lesion was finally recorded (measured FFR).

Results: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls’ formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640–0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion.

Conclusions: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.

Abstract

Background: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen­tial coronary stenosis without balloon inflation is hereby proposed.

Methods: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu­la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls’ formula. FFR of the remaining lesion was finally recorded (measured FFR).

Results: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls’ formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640–0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion.

Conclusions: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.

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Keywords

fractional flow reserve; myocardial; coronary stenosis; coronary circulation; percutaneous coronary intervention

About this article
Title

A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study

Journal

Cardiology Journal

Issue

Vol 26, No 4 (2019)

Pages

310-321

Published online

2019-06-27

DOI

10.5603/CJ.a2019.0067

Pubmed

31257567

Bibliographic record

Cardiol J 2019;26(4):310-321.

Keywords

fractional flow reserve
myocardial
coronary stenosis
coronary circulation
percutaneous coronary intervention

Authors

Juan Luis Gutiérrez-Chico
Carlos Cortés
Miłosz Jaguszewski
Michele Schincariol
Ignacio J. Amat-Santos
Juan A. Franco-Peláez
Grzegorz Żuk
Dariusz Ciećwierz
Wojciech Wojakowski
Felipe Navarro
Shengxian Tu
Borja Ibáñez

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