Quantification of disturbed coronary flow by disturbed vorticity index and relation with fractional flow reserve

Miao Chu, Clemens von Birgelen, Yingguang Li, Jelmer Westra, Junqing Yang, Niels R. Holm, Johan H.C. Reiber, William Wijns, Shengxian Tu* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Scopus)

Abstract

Background and aims: The relation between FFR and local coronary flow patterns is incompletely understood. We aimed at developing a novel hemodynamic index to quantify disturbed coronary flow, and to investigate its relationship with lesion-associated pressure-drop, and fractional flow reserve (FFR).

Methods: Three-dimensional angiographic reconstruction and computational fluid dynamics were applied to simulate pulsatile coronary flow. Disturbed vorticity index (DVI) was derived to quantify the stenosis-induced flow disturbance. The relation between DVI and pressure-drop was assessed in 9 virtual obstruction models. Furthermore, we evaluated the correlation between DVI, FFR, hyperemic flow velocity, and anatomic parameters in 84 intermediate lesions from 73 patients.

Results: In virtual models, DVI increased with increasing flow rate, stenosis severity, and lesion complexity. The correlation between DVI and pressure-drop across all models was excellent (determination coefficient R2 = 0.85, p < 0.001). In vivo, DVI showed a correlation with FFR (rho (ρ) = -0.74, p < 0.001) that was stronger than the relations of FFR with hyperemic flow velocity (ρ = -0.27, p=0.015), lesion length (ρ = -0.36, p=0.001) and percent diameter stenosis (ρ = -0.40, p < 0.001).

Conclusions: DVI, a novel index to quantify disturbed flow, was related to pressure-drop in virtual obstruction models and showed a strong inverse relation with FFR in intermediate lesions in vivo. It supports the prognostic value of FFR and may provide additional information about sources of energy loss when measuring FFR.

Original languageEnglish
Pages (from-to)136-144
Number of pages9
JournalAtherosclerosis
Volume273
DOIs
Publication statusPublished - 1 Jun 2018

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Keywords

  • UT-Hybrid-D
  • Coronary artery disease
  • Flow patterns
  • Fractional flow reserve
  • Vascular hemodynamics
  • Coronary angiography

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