Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions

Peter L. M. Kerkhof, Elena Osto, Francesco Tona, Guy R. Heyndrickx, Neal Handly

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

Abstract

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.
Original languageEnglish
Title of host publication2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019
PublisherInstitute of Electrical and Electronics Engineers Inc.
Pages7006-7009
ISBN (Electronic)9781538613115
DOIs
Publication statusPublished - 2019
Event41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019 - Berlin, Germany
Duration: 23 Jul 201927 Jul 2019

Publication series

NameProceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS
ISSN (Print)1557-170X

Conference

Conference41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019
CountryGermany
CityBerlin
Period23/07/201927/07/2019

Cite this

Kerkhof, P. L. M., Osto, E., Tona, F., Heyndrickx, G. R., & Handly, N. (2019). Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions. In 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019 (pp. 7006-7009). [8857589] (Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS). Institute of Electrical and Electronics Engineers Inc.. https://doi.org/10.1109/EMBC.2019.8857589
Kerkhof, Peter L. M. ; Osto, Elena ; Tona, Francesco ; Heyndrickx, Guy R. ; Handly, Neal. / Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions. 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019. Institute of Electrical and Electronics Engineers Inc., 2019. pp. 7006-7009 (Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS).
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abstract = "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.",
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language = "English",
series = "Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS",
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Kerkhof, PLM, Osto, E, Tona, F, Heyndrickx, GR & Handly, N 2019, Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions. in 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019., 8857589, Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS, Institute of Electrical and Electronics Engineers Inc., pp. 7006-7009, 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019, Berlin, Germany, 23/07/2019. https://doi.org/10.1109/EMBC.2019.8857589

Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions. / Kerkhof, Peter L. M.; Osto, Elena; Tona, Francesco; Heyndrickx, Guy R.; Handly, Neal.

2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019. Institute of Electrical and Electronics Engineers Inc., 2019. p. 7006-7009 8857589 (Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS).

Research output: Chapter in Book/Report/Conference proceedingConference contributionAcademicpeer-review

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.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/31947451

U2 - 10.1109/EMBC.2019.8857589

DO - 10.1109/EMBC.2019.8857589

M3 - Conference contribution

T3 - Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS

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BT - 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019

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Kerkhof PLM, Osto E, Tona F, Heyndrickx GR, Handly N. Sex-Specific Interpretation of Coronary Flow Reserve and Fractional Flow Reserve Metrics, Including Their Companions. In 2019 41st Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBC 2019. Institute of Electrical and Electronics Engineers Inc. 2019. p. 7006-7009. 8857589. (Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society, EMBS). https://doi.org/10.1109/EMBC.2019.8857589