Three-Dimensional Angiographic Characteristics versus Functional Stenosis Severity in Fractional and Coronary Flow Reserve Discordance: A DEFINE FLOW Sub Study
Valerie Stegehuis,
Jelmer Westra,
Coen Boerhout,
Martin Sejr-Hansen,
Ashkan Eftekhari,
Hernan Mejía-Renteria,
Maribel Cambero-Madera,
Niels Van Royen,
Hitoshi Matsuo,
Masafumi Nakayama,
Maria Siebes,
Evald Høj Christiansen,
Tim Van de Hoef,
Jan Piek
Affiliations
Valerie Stegehuis
Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
Jelmer Westra
Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
Coen Boerhout
Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
Martin Sejr-Hansen
Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
Ashkan Eftekhari
Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
Hernan Mejía-Renteria
Department of Cardiology, Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid, 28040 Madrid, Spain
Maribel Cambero-Madera
Tergooi Hospital, 1261 AN Blaricum, The Netherlands
Niels Van Royen
Department of Cardiology, Radboud University Nijmegen, 6525 XZ Nijmegen, The Netherlands
Hitoshi Matsuo
Gifu Heart Center, Gifu 500-8384, Japan
Masafumi Nakayama
Gifu Heart Center, Gifu 500-8384, Japan
Maria Siebes
Amsterdam UMC—Location AMC, Department of Biomedical Engineering and Physics, 1105 AZ Amsterdam, The Netherlands
Evald Høj Christiansen
Department of Cardiology, Aarhus University Hospital, Skejby, 8200 Aarhus, Denmark
Tim Van de Hoef
Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
Jan Piek
Amsterdam UMC—Location AMC, Department of Cardiology, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, 1105 AZ Amsterdam, The Netherlands
Background: Coronary angiography alone is insufficient to identify lesions associated with myocardial ischemia that may benefit from revascularization. Coronary physiology parameters may improve clinical decision making in addition to coronary angiography, but the association between 2D and 3D qualitative coronary angiography (QCA) and invasive pressure and flow measurements is yet to be elucidated. Methods: We associated invasive fractional flow reserve (FFR), coronary flow reserve (CFR) and coronary flow capacity (CFC) with 2D- and 3D-QCA in 430 intermediate lesions of 366 patients. Results: Overall, 2D-QCA analysis resulted in less severe stenosis severity compared with 3D-QCA analysis. FFR+/CFR− lesions had similar 3D-QCA characteristics as FFR+/CFR+ lesions. In contrast, vessels with FFR−/CFR+ discordance had 3D-QCA characteristics similar to those of vessels with concordant FFR−/CFR−. Contrarily, FFR+/CFR− lesions had CFC similar to that of as FFR-/CFR- lesions. Conclusions: Non-flow-limiting lesions (FFR+/CFR−) have 3D-QCA characteristics similar to those of FFR+/CFR+, but the majority are not associated with inducible myocardial ischemia as determined by invasive CFC. FFR−/CFR+ lesions have 3D-QCA characteristics similar to those of FFR−/CFR− lesions but are more frequently associated with a moderately to severely reduced CFC, illustrating the angiographic–functional mismatch in discordant lesions.
