Abstract 13616: Not Only the Degree of Epicardial Coronary Stenosis but Also Its Supply Area Affects Fractional Flow Reserve
Background: Fractional flow reserve (FFR) has been proposed as a clinical index to identify significant stenosis inducing reversible ischemia, and considered specific to epicardial coronary stenosis. Previous studies showed correlation between anatomical parameters of epicardial coronary stenosis and FFR. Nevertheless, the correlation between anatomical parameters and FFR has been either moderate or good but with a large dispersion of FFR values for a similar angiographic degree of stenosis. The amount of myocardium supplied might also influence the FFR value. The dispersion may be partially related to the pooling of both small and large supply area together in the same study cohort. However the impact of the supply area on the FFR value have not been adequately investigated yet. Thus the current study was designed to assess the effect of the supply area on the functional significance of coronary lesion.
Methods: A total of 296 lesions in 236 patients were assessed by quantitative coronary angiography and FFR. The supply area as percentage of left ventricle was estimated angiographically using a modified version of the Alberta Provivncia Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score (3.25 to 47.75%).
Results: FFR <0.75 was seen in 93 (31.4%) of the overall 296 lesions. There was a positive correlation between minimal lumen diameter (MLD) and FFR (R=0.584, P<0.001), and negative correlation between lesion length and FFR (R=-0.306, P<0.001), and between supply area (modified APPROACH score) and FFR (R=-0.408, P <0.001). The independent determinants of functionally significant stenosis based on FFR were MLD (odds ratio[OR] 0.022; confidential interval[CI]0.007-0.062; P<0.001), lesion length (OR 1.049; CI 1.020-1.079; P=0.001), and the supply area (OR 1.102; CI 1.068-1.137; P<0.001).
Conclusion: Not only the anatomical parameters of epicardial coronary stenosis but also its supply area affects the functional significance of coronary artery stenosis. Functional significance of coronary stenosis depends on the balance of the lesion severity and its supply area.
- © 2012 by American Heart Association, Inc.