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. 1998 Dec;80(6):539–542. doi: 10.1136/hrt.80.6.539

Coronary pressure measurement and fractional flow reserve

N Pijls 1, B De Bruyne 1
PMCID: PMC1728867  PMID: 10065019

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Figure 1  .

Figure 1  

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Schematic illustration of the coronary artery and its dependent myocardial vascular bed. Myocardial blood flow equals the perfusion pressure across the myocardium, divided by myocardial resistance. Because at maximum arteriolar vasodilatation resistance is minimal and constant (Rmin), maximum flow in the stenotic situation as a ratio to normal maximum flow equals the ratio of the myocardial perfusion pressure in the presence of the stenosis (Pd − Pv) to normal myocardial perfusion pressure (Pa − Pv), both measured after administration of a maximum hyperaemic stimulus. In other words, FFR equals (Pd − Pv)/(Pa − Pv ), which is generally very close to Pd/Pa . In this example, FFR equals 0.70. AO, aorta; Pa, Pd, and Pv, mean aortic, distal coronary, and central venous pressure measured at maximum coronary hyperaemia; Qmax , normal, maximum achievable myocardial flow if the coronary artery were normal; Qmax, stenosis, maximum achievable myocardial flow in the presence of a stenosis; Rmin indicates minimal resistance of the myocardial vascular bed.

Figure 2  .

Figure 2  

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Features of coronary flow reserve (CFR) and fractional flow reserve (FFR). The coronary pressure-flow relation at maximum hyperaemia is indicated both for a normal coronary artery and a coronary stenosis. The resting pressure-flow relation (autoregulatory range) is represented by the solid horizontal line. (Left) CFR is defined as the ratio of hyperaemic to resting flow (a/b). It is obvious that with changing blood pressure, the value of CFR changes to a'/b'. Also, when resting flow changes (as with changing heart rate or contractility) CFR changes to a/b". Therefore, no uniform normal value of CFR can be defined. (Right) FFR is defined as the ratio of maximum flow in the presence of a stenosis divided by normal maximum flow (a/c). This ratio remains unaffected by changes in blood pressure (a/c = a'/c') or by variations in resting flow. Its normal value is always 1.0 , irrespective of the patient, coronary artery, or prevailing haemodynamic conditions. Therefore, FFR is a more specific measure of functional stenosis severity.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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