TY - JOUR
T1 - Influence of Collaterals on True FFR Prediction for a Left Main Stenosis with Concomitant Lesions
T2 - An In Vitro Study
AU - Coppel, Ricardo
AU - Lagache, Manuel
AU - Finet, Gérard
AU - Rioufol, Gilles
AU - Gómez, Armida
AU - Dérimay, François
AU - Malvé, Mauro
AU - Yazdani, Saami K.
AU - Pettigrew, Roderic I.
AU - Ohayon, Jacques
N1 - Publisher Copyright:
© 2019, Biomedical Engineering Society.
PY - 2019/6/15
Y1 - 2019/6/15
N2 - With the aim of assisting interventional cardiologists during decision making for revascularization, reduced-order (0D) approaches have been developed to predict the true fractional flow reserve (FFR True ) of individual stenoses in multiple-lesion arrangements. In this study, a general equation was derived to predict the FFR True of a left main (LM) coronary stenosis with downstream lesions, one in the left anterior descending (LAD) and the other in the left circumflex (LCx) artery, and distinct collateral circulations supplying each daughter artery. An in vitro model mimicking the fractal nature of LM bifurcation trees with collateral branches was developed to validate the FFR values obtained with the prediction model (FFR Pred Model ). Our results demonstrated that: (1) considering collaterals significantly improved the FFR Pred Model estimation for a moderate LM stenosis with two downstream lesions as compared to computations with no collateral consideration (p < 0.001): mean absolute error |FFR Pred Model − FFR True | ± SD was equal to 0.02 ± 0.01 vs. 0.04 ± 0.02 respectively, and (2) Deviations from FFR True for LM stenoses are correlated to both, downstream lesion severities and collateral developments. The present study supports the hypothesis that collateral circulations supplying the LAD and LCx must be considered when predicting the FFR True of an LM stenosis with downstream lesions.
AB - With the aim of assisting interventional cardiologists during decision making for revascularization, reduced-order (0D) approaches have been developed to predict the true fractional flow reserve (FFR True ) of individual stenoses in multiple-lesion arrangements. In this study, a general equation was derived to predict the FFR True of a left main (LM) coronary stenosis with downstream lesions, one in the left anterior descending (LAD) and the other in the left circumflex (LCx) artery, and distinct collateral circulations supplying each daughter artery. An in vitro model mimicking the fractal nature of LM bifurcation trees with collateral branches was developed to validate the FFR values obtained with the prediction model (FFR Pred Model ). Our results demonstrated that: (1) considering collaterals significantly improved the FFR Pred Model estimation for a moderate LM stenosis with two downstream lesions as compared to computations with no collateral consideration (p < 0.001): mean absolute error |FFR Pred Model − FFR True | ± SD was equal to 0.02 ± 0.01 vs. 0.04 ± 0.02 respectively, and (2) Deviations from FFR True for LM stenoses are correlated to both, downstream lesion severities and collateral developments. The present study supports the hypothesis that collateral circulations supplying the LAD and LCx must be considered when predicting the FFR True of an LM stenosis with downstream lesions.
KW - Bifurcation lesion
KW - Coronary collateral flow
KW - Fractional flow reserve
KW - Left main coronary stenosis
KW - Multiple stenoses
KW - Prediction model
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U2 - 10.1007/s10439-019-02235-y
DO - 10.1007/s10439-019-02235-y
M3 - Article
C2 - 30843148
AN - SCOPUS:85062702794
SN - 0090-6964
VL - 47
SP - 1409
EP - 1421
JO - Annals of Biomedical Engineering
JF - Annals of Biomedical Engineering
IS - 6
ER -