Abstract
Cardiovascular disease is one of the world’s leading causes of morbidity and mortality. Fractional flow reserve (FFR) was proposed in the 1990s to more accurately evaluate the functional severity of intermediate coronary stenosis, and it is currently the gold standard in cardiac catheterization laboratories where coronary pressure and flow are routinely obtained. The clinical measurement of FFR relies on a pressure wire for the recording of pressures; however, in computational fluid dynamics studies, an FFR is frequently predicted using a wire-absent model. We aim to investigate the influence of the physical presence of a 0.014-inch (≈0.36 mm) pressure wire in the calculation of virtual FFR. Ideal and patient-specific models were simulated with the absence and presence of a pressure wire. The computed FFR reduced from 0.96 to 0.93 after inserting a wire in a 3-mm non-stenosed (pipe) ideal model. In mild stenotic cases, the difference in FFR between the wire-absent and wire-included models was slight. The overestimation in severe case was large but is of less clinical significance because, in practice, this tight lesion does not require sophisticated measurement to be considered critical. However, an absence of the pressure wire in simulations could contribute to an over-evaluation for an intermediate coronary stenosis.
Highlights
We investigate the influence of the physical presence of a pressure wire, using computational fluid dynamics (CFD) simulations
A physical comparison between the size of the pressure wire and of the vessel is present via analyzing the blockage ratio (Table 1)
The blockage ratio is equal to the area of wire (Awire ) divided by the minimal lumen area (MLA) (Equation (3)): Blockage Ratio =
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The risk of arterial stenosis is a large health care burden worldwide. In the investigation of atherothrombosis-related events, the REACH (REduction of Atherothrombosis for Continued Health) Registry recruited approximately 68,000 patients from 44 countries across six regions. Statistical analysis illustrated that as many as 30% of coronary artery disease (CAD) patients had systemic atherosclerotic disease (disease in more than one arterial bed) [1]. Both routine diagnosis using medical imaging techniques and invasive functional assessment procedures are used for stenosis identification in coronary arteries
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