RT Journal Article
T1 Influence of the pressure wire on the fractional flow reserve calculation: CFD analysis of an ideal vessel and clinical patients with stenosis
A1 Otero-Cacho, Alberto
A1 Insúa-Villa, Manuel
A1 López-Otero, Diego
A1 Díaz-Fernández, Brais
A1 Bastos-Fernández, María
A1 Pérez Muñuzuri, Vicente
A1 Pérez Muñuzuri, Alberto
A1 González Juanatey, José Ramón
K1 Stenosis
K1 Fractional flow reserve
K1 CFD modeling
K1 Pressure wire
K1 Computed tomography
AB Background and objectiveFractional Flow Reserve (FFR) is generally considered the gold standard in hemodynamics to assess the impact of a stenosis on the blood flow. The standard procedure to measure involves the displacement of a pressure guide along the circulatory system until it is placed next to the lesion to be analyzed. The main objective of the present study is to analyze the influence of the pressure guide on the invasive FFR measurements and its implications in clinical practice.MethodsWe studied the influence of pressure wires on the measurement of Fractional Flow Reserve (FFR) through a combination of Computational Fluid Dynamics (CFD) simulations using 45 clinical patient data with 58 lesions and ideal geometries. The analysis is conducted considering patients that were subjected to a computer tomography and also have direct measurements using a pressure guide. Influence of the stenosis severity, degree of occlusion and blood viscosity has also been studied.ResultsThe influence of pressure wires specifically affects severe stenosis with a lumen diameter reduction of 50 % or greater. This type of stenosis leads to reduced hyperemic flow and increased coronary pressure drop. Thus, we identified that the placement of wires during FFR measurements results in partial obstruction of the coronary artery lumen, leading to increased pressure drop and subsequent reduction in blood flow. The severity of low FFR values associated with severe stenosis may be prone to overestimation when compared to stenosis without severe narrowing. These results have practical implications, particularly in the interpretation of lesions falling within the “gray zone” (0,75−0,80).ConclusionsThe pressure wire's presence significantly alters the flow on severe lesions, which has an impact on the FFR calculation. In contrast, the impact of the pressure wire appears to be reduced when the FFR is larger than 0.8. The findings provide critical information for physicians, emphasizing the need for cautious interpretation of FFR values, particularly in severe stenosis. It also offers insights into improving the correlation between FFRct models and invasive measurements by incorporating the influence of pressure wires.
PB Elsevier
YR 2024
FD 2024-07-14
LK https://hdl.handle.net/10347/37572
UL https://hdl.handle.net/10347/37572
LA eng
NO This research has been supported by the Xunta de Galicia (Grant No. 2021-PG036-1), Sociedad Española de Cardiología (SEC/FEC-INV-CLI 22/04), the Spanish Ministerio de Ciencia e Innovación (Grants No. PID2022-138322OB-I00, PID2022-141626NB-I00, MCIN/AEI/10.13039/501100011033), European Union Next Generation EU/PRTR (Grant No: DIN2020-011068) and Interreg VI-A Spain. All these programs are co-funded by ERDF (EU).
DS Minerva
RD 23 abr 2026