The relationship between coronary artery distensibility and fractional flow reserve

Andy S C Yong; Ashkan Javadzadegan; William F Fearon; Abouzar Moshfegh; Jerrett K Lau; Stephen Nicholls; Martin K C Ng; Leonard Kritharides

doi:10.1371/journal.pone.0181824

The relationship between coronary artery distensibility and fractional flow reserve

PLoS One. 2017 Jul 25;12(7):e0181824. doi: 10.1371/journal.pone.0181824. eCollection 2017.

Authors

Andy S C Yong^{1

2

3}, Ashkan Javadzadegan^{1

2}, William F Fearon⁴, Abouzar Moshfegh^{1

2}, Jerrett K Lau², Stephen Nicholls⁵, Martin K C Ng⁶, Leonard Kritharides^{2

3}

Affiliations

¹ Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
² ANZAC Research Institute, The University of Sydney, Sydney, New South Wales, Australia.
³ Department of Cardiology, Concord Hospital, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California, United States of America.
⁵ South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
⁶ Royal Prince Alfred Hospital, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Discordance between angiography-based anatomical assessment of coronary stenosis severity and fractional flow reserve (FFR) has been attributed to several factors including lesion length and irregularity, and the myocardial territory supplied by the target vessel. We sought to examine if coronary arterial distensibility is an independent contributor to this discordance. There were two parts to this study. The first consisted of "in silico" models of 26 human coronary arteries. Computational fluid dynamics-derived FFR was calculated for fully rigid, partially distensible and fully distensible models of the 26 arteries. The second part of the study consisted of 104 patients who underwent coronary angiography and FFR measurement. Distensibility at the lesion site (DistensibilityMLA) and for the reference vessel (DistensibilityRef) was determined by analysing three-dimensional angiography images during end-systole and end-diastole. Computational fluid dynamics-derived FFR was 0.67±0.19, 0.70±0.18 and 0.75±0.17 (P<0.001) in the fully rigid, partially distensible and fully distensible models respectively. FFR correlated with both DistensibilityMLA (r = 0.36, P<0.001) and DistensibilityRef (r = 0.44, P<0.001). Two-way ANCOVA analysis revealed that DistensibilityMLA (F (1, 100) = 4.17, p = 0.031) and percentage diameter stenosis (F (1, 100) = 60.30, p < 0.01) were both independent predictors of FFR. Coronary arterial distensibility is a novel, independent determinant of FFR, and an important factor contributing to the discordance between anatomical and functional assessment of stenosis severity.

MeSH terms

Computer Simulation
Coronary Angiography
Coronary Stenosis / physiopathology
Coronary Vessels / physiopathology*
Female
Fractional Flow Reserve, Myocardial / physiology*
Humans
Imaging, Three-Dimensional
Male
Middle Aged

Grants and funding

Associate Professor Yong was supported by a National Heart Foundation of Australia Future Leader Fellowship (ID 100448) and a Sir Roy McCaughey Research Establishment Grant from the RACP. Professor Kritharides was supported by a National Health and Medical Research Council program grant (ID 1037903). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.