King's College London

Research portal

Hyperemic hemodynamic characteristics of serial coronary lesions assessed by pullback pressure gradients

Research output: Contribution to journalArticlepeer-review

Alessandro Candreva, Takuya Mizukami, Jeroen Sonck, Daniel Munhoz, Sakura Nagumo, Giuseppe Di Gioia, Emanuele Gallinoro, Niya Mileva, Jozef Bartunek, Eric Wyffels, Emanuele Barbato, Bernard De Bruyne, Divaka Perera, Carlos Collet

Original languageEnglish
Pages (from-to)E647-E654
Issue number5
Early online date15 Jul 2021
Accepted/In press2021
E-pub ahead of print15 Jul 2021
Published1 Nov 2021

Bibliographical note

Funding Information: Dr. Giuseppe Di Gioia. Dr. Jeroen Sonck and Dr. Daniel Munhoz are supported by a research grant from the CardioPaTh PhD program; Dr. Giuseppe Di Gioia is supported by the STAR program of the Compagnia di San Paolo. Funding Information: Dr. Carlos Collet Bortone has received institutional consultancy fees from Heart Flow and Philips Volcano; Dr. Bernard De Bruyne discloses institutional consulting fees from Abbott Vascular, Boston Scientific, Opsens, and Siemens, Institutional grant support from Abbott Vascular, Boston Scientific, Biotronic, Medtronic and holds equities in Philips, Siemens, GE, Bayer, HeartFlow, Edwards Lifesciences and Ceyliad. Dr. Emanuele Barbato discloses speaker's fees from Insight Lifetech, Boston Scientific, Abbott Vascular. The remaining authors have nothing to disclose. Publisher Copyright: © 2021 Wiley Periodicals LLC. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Objectives: To characterize hemodynamics of serial coronary stenoses using fractional flow reserve (FFR) pullbacks and the pullback pressure gradients (PPG) index. Background: The cross-talk between stenoses within the same coronary artery makes the prediction of the functional contribution of each lesion challenging. Methods and results: One-hundred seventeen patients undergoing coronary angiography for stable angina were prospectively recruited. Serial lesions were defined as two or more narrowings with visual diameter stenosis >50% on conventional angiography. Motorized FFR pullback tracings were obtained at 1 mm/s. Pullbacks were visually adjudicated as presenting two, one, and no focal pressure drops. The pattern of disease (i.e., focal or diffuse) was quantified using the PPG index. Twenty-five vessels presented serial lesions (mean PPG 0.48 ± 0.17). Two, one or no focal pressure drops were observed in 40% (n = 10; PPG 0.59 ± 0.17), 52% (n = 13; PPG 0.44 ± 0.12) and 8% of cases (n = 2; PPG 0.27 ± 0.01; p-value = 0.01). Distal FFR was similar between vessels with two, one and no focal pressure drops in the pullback curve (p-value = 0.27). The PPG index independently predicted the presence of two focal pressure drops in the pullback curve (p = 0.04). Conclusions: FFR pullbacks in serial coronary lesions exhibit three distinct functional patterns. High PPG was associated with pullback curves presenting two pressure drops. The PPG provides a quantitative assessment of the pattern of coronary artery disease in cases with serial lesions and might be useful to assess the appropriateness of percutaneous revascularization.

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454