Published Online
on February 11, 2002

A more recent version of this article appeared on March 5, 2002

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Submitted on October 3, 2001
Revised on December 13, 2001
Accepted on December 21, 2001

Validation of Collateral Fractional Flow Reserve by Myocardial Perfusion Imaging

Hitoshi Matsuo MD^*, Sachiro Watanabe MD, Tohru Kadosaki MD, Takahiko Yamaki MD, Shinichiro Tanaka MD, Shuusaku Miyata MD, Tomonori Segawa MD, Yukihiko Matsuno MD, Masaaki Tomita MD, and Hisayoshi Fujiwara MD

From the Department of Cardiology, Prefectural Gifu Hospital, and the Second Department of Internal Medicine (H.F.), Gifu University School of Medicine, Gifu City, Japan.

^* To whom correspondence should be addressed. E-mail: matsuo{at}iri.rd.pref.gifu.jp.

Background—Collateral fractional flow reserve (FFR_coll) is an index to quantify collateral blood flow, derived from coronary pressure measurements. Although well defined theoretically, its direct validation by myocardial perfusion imaging has not been established so far. Validating this index by myocardial perfusion imaging is the main aim of this study.

Methods and Results—Twenty-four consecutive patients with stable angina and single left anterior descending artery stenosis underwent simultaneous measurement of aortic pressure (P_a), coronary wedge pressure (P_w), and central venous pressure (P_v) during balloon inflation. FFR_coll was calculated and compared with the extent and severity of the defect during coronary occlusion using ^99mTc-sestamibi imaging at balloon inflation of the respective coronary artery. Although the pressure-derived collateral indexes (P_w, P_w/P_a, and FFR_coll) ranged widely, they were closely correlated with extent and severity scores of the nuclear occlusion images and superior to the ECG for that purpose. Of all parameters, FFR_coll correlated best with the severity score at imaging (r=-0.88), followed by the P_w/P_a ratio (r=-0.74) or P_w alone (r=-0.69).

Conclusions—FFR_coll, calculated from coronary pressure during balloon occlusion, is highly correlated with the extent and severity of the defect at myocardial perfusion of the territory of the occluded artery and can be used for quantitative assessment of collateral blood flow in conscious humans.

Key words: collateral circulation • blood flow • perfusion • imaging • pressure

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