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A. Left, cineangiographic frame showing the left coronary artery with a severe lesion in the circumflex artery (red arrow) and moderate lesioin in the LAD
(black arrow). Right, diagram of eccentric lesion with three different angiographic projections in which the lumen may be assessed as mild, moderate, or
severe depending on which projection is accepted. Because of the two-dimensional image projection, the severity of some lesioins, especially those in the
intermediate range, do not reflect the flow impairment and thus require fractional flow reserve for accurate assessment. B. Coronary pressure and flow
measurements and the relationship determines the ischemic potential of a stenosis. Top left, cineangiogram frame showing stenosis. There are seven
features that contribute to resistance to flow, length being only one. Bottom left, diagram of a stenosis and factors that equate the change in pressure to
Source: CARDIAC CATHETERIZATION, CARDIAC ANGIOGRAPHY, AND CORONARY BLOOD FLOW AND PRESSURE MEASUREMENTS,
two factors of viscous friction and energy loss due to flow separation, right translesional pressure drop compared to change in flow (horizontal). For each
Hurst's The Heart, 14e
severity of flow, the pressure-flow relationship becomes steeper.
Citation: Fuster V, Harrington RA, Narula J, Eapen ZJ. Hurst's The Heart, 14e; 2017 Available at: http://mhmedical.com/ Accessed: August 02,
2017
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