TY - GEN
T1 - Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions
AU - Kerkhof, Peter L. M.
AU - Osto, Elena
AU - Tona, Francesco
AU - Heyndrickx, Guy R.
AU - Handly, Neal
PY - 2019
Y1 - 2019
N2 - BACKGROUND: Impairment of coronary flow is usually evaluated by considering the ratio of two measurements. Fractional flow reserve (FFR) estimates impact on an epicardial artery by taking mean post-stenotic pressure divided by mean aortic pressure, both obtained during adenosine induced hyperemia. Coronary flow reserve (CFR) compares hyperemic flow or velocity with the baseline situation, also as a ratio. As severity of underlying pathology may differ for men and women, we investigate the impact of these differences on relevant metrics.METHODS: As sex associated differences may cancel out in a ratio, this weakness of a ratio can be compensated by analyzing the intrinsic companion (C) and consider polar coordinates. Thus, besides the familiar ratio based metrics, we also analyze FFRC and CFRC. Outcomes of in silico studies are employed to extrapolate actual patient data and predict consequences. For FFR 129 patients (38 women) were invasively studied using pressure wires. CFR was measured noninvasively for the left anterior descending coronary artery by recording ultrasound based Doppler velocity in 114 individuals (28 women).RESULTS: The FFR can be identified as an indicator of the pressure gradient over the stenosis (R=-0.90), while FFRC differs for men compared to women (P=0.04) and correlates (R=0.93) with post-stenotic driving pressure. CFR shows a difference for men versus women (P=0.04) and is best associated with hyperemic flow (R=0.64), whereas CFRC relates to hyperemia recruited velocity (R=0.97). Simulation studies show that FFR may differ for both sexes when considering elderly.CONCLUSIONS: Analysis of ratios require inclusion of the companion, and sex-specific differences deserve attention.
AB - BACKGROUND: Impairment of coronary flow is usually evaluated by considering the ratio of two measurements. Fractional flow reserve (FFR) estimates impact on an epicardial artery by taking mean post-stenotic pressure divided by mean aortic pressure, both obtained during adenosine induced hyperemia. Coronary flow reserve (CFR) compares hyperemic flow or velocity with the baseline situation, also as a ratio. As severity of underlying pathology may differ for men and women, we investigate the impact of these differences on relevant metrics.METHODS: As sex associated differences may cancel out in a ratio, this weakness of a ratio can be compensated by analyzing the intrinsic companion (C) and consider polar coordinates. Thus, besides the familiar ratio based metrics, we also analyze FFRC and CFRC. Outcomes of in silico studies are employed to extrapolate actual patient data and predict consequences. For FFR 129 patients (38 women) were invasively studied using pressure wires. CFR was measured noninvasively for the left anterior descending coronary artery by recording ultrasound based Doppler velocity in 114 individuals (28 women).RESULTS: The FFR can be identified as an indicator of the pressure gradient over the stenosis (R=-0.90), while FFRC differs for men compared to women (P=0.04) and correlates (R=0.93) with post-stenotic driving pressure. CFR shows a difference for men versus women (P=0.04) and is best associated with hyperemic flow (R=0.64), whereas CFRC relates to hyperemia recruited velocity (R=0.97). Simulation studies show that FFR may differ for both sexes when considering elderly.CONCLUSIONS: Analysis of ratios require inclusion of the companion, and sex-specific differences deserve attention.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85077892711&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31947451
U2 - https://doi.org/10.1109/EMBC.2019.8857589
DO - https://doi.org/10.1109/EMBC.2019.8857589
M3 - Conference contribution
C2 - 31947451
T3 - Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
SP - 7006
EP - 7009
BT - 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019
PB - Institute of Electrical and Electronics Engineers Inc.
T2 - 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019
Y2 - 23 July 2019 through 27 July 2019
ER -