Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions
Abstract A significant proportion of stenoses have an abnormal fractional flow reserve (FFR) after angiographically successful percutaneous coronary intervention (PCI), which is traditionally attributed to differences in coronary flow velocity reserve (CFVR) or hyperemic microvascular resistance (hM...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-07-01
|
| Series: | Physiological Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.14814/phy2.70440 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849431072211730432 |
|---|---|
| author | Ahmet Tas Alp Ozcan Yaren Alan Sabahattin Umman Kim H. Parker Tim P. van de Hoef Murat Sezer Jan J. Piek |
| author_facet | Ahmet Tas Alp Ozcan Yaren Alan Sabahattin Umman Kim H. Parker Tim P. van de Hoef Murat Sezer Jan J. Piek |
| author_sort | Ahmet Tas |
| collection | DOAJ |
| description | Abstract A significant proportion of stenoses have an abnormal fractional flow reserve (FFR) after angiographically successful percutaneous coronary intervention (PCI), which is traditionally attributed to differences in coronary flow velocity reserve (CFVR) or hyperemic microvascular resistance (hMR). This study investigated the mechanisms underlying residual low FFR despite good angiographic results and normalized hyperemic stenosis resistance (hSR) using wave‐intensity analysis (WIA), which evaluates phasic characteristics of cardiac‐coronary coupling. Sixty‐three vessels from patients who underwent PCI for stable intermediate stenoses were included. Peri‐PCI characteristics of conventional and WIA parameters were assessed. Ten (16%) vessels exhibited residual low FFR (≤0.8) despite normalized hSR (<0.8), without significant differences in hyperemic flow (velocity) (hAPV), CFVR, or hMR compared with concordant normal FFR‐hSR group (p > 0.05). WIA revealed a significantly slower (peak‐time of backward expansion wave, tBEWpeak = 20% ± 6% vs. 29% ± 17% of expansion period, p = 0.005) and weaker (BEWpeak = 10.1 ± 8.9 vs. 15.8 ± 11.4 10.kW.m‐2.s‐2, p = 0.045) impact of microvascular suction responsible for diastolic coronary filling during hyperemia in the low FFR group, despite comparable pre‐PCI characteristics. Residual low FFR after PCI may reflect altered cardiac‐coronary coupling without limitation of flow or vasodilator capacity when the blunted impact of accelerating wave energy flux with delayed coronary filling fails to sustain distal pressure. The influence of cardiac‐coronary coupling on post‐PCI FFR warrants further investigation. |
| format | Article |
| id | doaj-art-d9525ec19e8b4d378a50bc8ec6c70e2b |
| institution | Kabale University |
| issn | 2051-817X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj-art-d9525ec19e8b4d378a50bc8ec6c70e2b2025-08-20T03:27:44ZengWileyPhysiological Reports2051-817X2025-07-011313n/an/a10.14814/phy2.70440Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventionsAhmet Tas0Alp Ozcan1Yaren Alan2Sabahattin Umman3Kim H. Parker4Tim P. van de Hoef5Murat Sezer6Jan J. Piek7Department of Cardiology Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences Amsterdam the NetherlandsFaculty of Medicine Istanbul University Istanbul TurkeyFaculty of Medicine Istanbul University Istanbul TurkeyDepartment of Cardiology Istanbul University Istanbul TurkeyDepartment of Bioengineering Imperial College London UKDepartment of Cardiology University Medical Center Utrecht Utrecht the NetherlandsDepartment of Cardiology Acibadem International Hospital Istanbul TurkeyDepartment of Cardiology Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences Amsterdam the NetherlandsAbstract A significant proportion of stenoses have an abnormal fractional flow reserve (FFR) after angiographically successful percutaneous coronary intervention (PCI), which is traditionally attributed to differences in coronary flow velocity reserve (CFVR) or hyperemic microvascular resistance (hMR). This study investigated the mechanisms underlying residual low FFR despite good angiographic results and normalized hyperemic stenosis resistance (hSR) using wave‐intensity analysis (WIA), which evaluates phasic characteristics of cardiac‐coronary coupling. Sixty‐three vessels from patients who underwent PCI for stable intermediate stenoses were included. Peri‐PCI characteristics of conventional and WIA parameters were assessed. Ten (16%) vessels exhibited residual low FFR (≤0.8) despite normalized hSR (<0.8), without significant differences in hyperemic flow (velocity) (hAPV), CFVR, or hMR compared with concordant normal FFR‐hSR group (p > 0.05). WIA revealed a significantly slower (peak‐time of backward expansion wave, tBEWpeak = 20% ± 6% vs. 29% ± 17% of expansion period, p = 0.005) and weaker (BEWpeak = 10.1 ± 8.9 vs. 15.8 ± 11.4 10.kW.m‐2.s‐2, p = 0.045) impact of microvascular suction responsible for diastolic coronary filling during hyperemia in the low FFR group, despite comparable pre‐PCI characteristics. Residual low FFR after PCI may reflect altered cardiac‐coronary coupling without limitation of flow or vasodilator capacity when the blunted impact of accelerating wave energy flux with delayed coronary filling fails to sustain distal pressure. The influence of cardiac‐coronary coupling on post‐PCI FFR warrants further investigation.https://doi.org/10.14814/phy2.70440coronary artery diseasefractional flow reservehyperemic stenosis resistancePCIwave intensity analysis |
| spellingShingle | Ahmet Tas Alp Ozcan Yaren Alan Sabahattin Umman Kim H. Parker Tim P. van de Hoef Murat Sezer Jan J. Piek Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions Physiological Reports coronary artery disease fractional flow reserve hyperemic stenosis resistance PCI wave intensity analysis |
| title | Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions |
| title_full | Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions |
| title_fullStr | Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions |
| title_full_unstemmed | Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions |
| title_short | Altered cardiac‐coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions |
| title_sort | altered cardiac coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions |
| topic | coronary artery disease fractional flow reserve hyperemic stenosis resistance PCI wave intensity analysis |
| url | https://doi.org/10.14814/phy2.70440 |
| work_keys_str_mv | AT ahmettas alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT alpozcan alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT yarenalan alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT sabahattinumman alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT kimhparker alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT timpvandehoef alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT muratsezer alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions AT janjpiek alteredcardiaccoronarycouplingrelatestoabnormalfractionalflowreservewithoutflowlimitationafterpercutaneouscoronaryinterventions |