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Influence of different physiological hemodynamics on fractional flow reserve values in the left coronary artery and right coronary artery

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Abstract

Background

Although the left coronary artery (LCA) has a flow profile in that most blood flow occurs during diastole rather than systole, the right coronary artery (RCA) has a flow pattern that is less diastolic dominant. This study assessed whether coronary pressure waveforms distal to stenoses with the same fractional flow reserve (FFR) was the same between the LCA and RCA.

Methods

A total of 347 vessels from 318 patients who underwent FFR measurements were included. Conventional FFR was calculated as the ratio of the mean coronary distal pressure (Pd) to the mean aortic pressure (Pa) at maximal hyperemia. The pressure drop ratios in systole (PDRsystole) and diastole (PDRdiastole) were calculated as the sum of (Pa minus Pd) divided by the sum of Pa at the intracoronary diastolic and systolic pressure phases, respectively.

Results

Analysis of covariance of the regression line of correlation between conventional FFR and PDRsystole revealed that the slope was significantly greater in the RCA than in the left anterior descending artery (LAD) and left circumflex artery (LCX) (−0.765, −0.578, and −0.589, p < 0.001). On the other hand, the regression line of correlation between conventional FFR and PDRdiastole found that the slope was significantly greater in the LAD and LCX than in the RCA (−1.349, −1.318, and −1.223, p < 0.001).

Conclusions

The pressure waveform distal to the stenosis differs between the LCA and RCA. In the LCA, the decrease in diastolic pressure mainly contributed to the drop in FFR, whereas in the RCA, it was the decrease in systolic pressure.

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Acknowledgements

The authors thank the staff in the catheterization laboratory at Kansai Medical University for their excellent assistance during the study.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Osaka, 5731010, Japan

    Kensaku Wada, Kenichi Fujii, Keita Horitani, Hiroshi Kishimoto, Kenta Hashimoto, Hiroki Shibutani, Satoshi Tsujimoto, Shun Morishita, Masayoshi Iwasaki & Ichiro Shiojima

  2. Department of Cardiology, Kansai Medical University Medical Center, Moriguchi, Japan

    Koichiro Matsumura & Munemitsu Otagaki

Authors
  1. Kensaku Wada
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  2. Kenichi Fujii
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  3. Keita Horitani
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  4. Hiroshi Kishimoto
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  5. Kenta Hashimoto
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  6. Hiroki Shibutani
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  7. Satoshi Tsujimoto
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  8. Koichiro Matsumura
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  9. Munemitsu Otagaki
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  11. Masayoshi Iwasaki
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  12. Ichiro Shiojima
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Corresponding author

Correspondence to Kenichi Fujii.

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The ethics committee at Kansai Medical University (approved number 2020037).

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Wada, K., Fujii, K., Horitani, K. et al. Influence of different physiological hemodynamics on fractional flow reserve values in the left coronary artery and right coronary artery. Heart Vessels 36, 1125–1131 (2021). https://doi.org/10.1007/s00380-021-01797-z

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  • DOI: https://doi.org/10.1007/s00380-021-01797-z

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