Coronary Physiology Flashcards
What does FFR measure in the coronary arteries?
A. The velocity of blood flow
B. The percentage of coronary flow across a stenosis compared to normal flow
C. The total volume of blood in the coronary arteries
D. The electrical activity of the heart
B. The percentage of coronary flow across a stenosis compared to normal flow
What does FFR measure in the coronary arteries?
A. The velocity of blood flow
B. The percentage of coronary flow across a stenosis compared to normal flow
C. The total volume of blood in the coronary arteries
D. The electrical activity of the heart
B. The percentage of coronary flow across a stenosis compared to normal flow
What is the formula used to calculate FFR?
A. Systolic blood pressure / Diastolic blood pressure
B. Distal coronary pressure / Proximal aortic pressure during maximal hyperemia
C. Heart rate x Stroke volume
D. Resistance / Flow
B. Distal coronary pressure / Proximal aortic pressure during maximal hyperemia
What physiological state is required for accurate FFR measurement?
A. Resting conditions
B. Moderate exercise
C. Maximal hyperemia
D. Deep inspiration
C. Maximal hyperemia
Which device is typically used to measure distal coronary pressure in FFR assessment?
A. Standard angiographic catheter
B. 0.014-inch pressure sensor guidewire
C. External blood pressure cuff
D. Doppler ultrasound probe
B. 0.014-inch pressure sensor guidewire
Where is the high-fidelity pressure transducer located on the pressure wire?
A. At the very tip of the wire
B. 3 cm from the tip at the junction of radiopaque and radiolucent segments
C. At the proximal end of the wire
D. Outside the body in a monitoring console
B. 3 cm from the tip at the junction of radiopaque and radiolucent segments
Why is maximal hyperemia necessary for FFR measurement?
A. To reduce heart rate variability
B. To ensure coronary resistance is at a minimum and flow is linearly related to pressure
C. To stabilize the patient’s condition before angioplasty
D. To prevent arrhythmias during the procedure
B. To ensure coronary resistance is at a minimum and flow is linearly related to pressure
What does an FFR value of 0.80 or lower indicate?
A. No significant stenosis
B. A non-flow-limiting stenosis
C. A hemodynamically significant stenosis
D. Normal coronary flow
C. A hemodynamically significant stenosis
Which of the following can also be used instead of a pressure wire to measure FFR?
A. Intracardiac echocardiography
B. Optical microcatheter
C. CT angiography
D. Pulse oximeter
B. Optical microcatheter
What is the formula for myocardial fractional flow reserve (FFRmyo)?
A. Pd / Pa
B. (Pd - Pv) / (Pa - Pv)
C. 1 - ΔP / (Pa - Pw)
D. Pa / Pd
B. (Pd - Pv) / (Pa - Pv)
How is coronary fractional flow reserve (FFRcor) calculated?
A. 1 - ΔP / (Pa - Pw)
B. Pd / Pa
C. (Pa - Pw) / Pd
D. 1 - Pv / Pd
A. 1 - ΔP / (Pa - Pw)
What does collateral fractional flow reserve (FFRcoll) represent?
A. The ratio of Pd to Pa
B. The difference between FFRmyo and FFRcor
C. The percentage of normal flow across a lesion
D. The pressure gradient across a collateral vessel
B. The difference between FFRmyo and FFRcor
Which pressure measurement is NOT taken during hyperemia?
A. Pa (Mean aortic pressure)
B. Pd (Distal coronary pressure)
C. Pw (Mean coronary wedge pressure)
D. ΔP (Mean translesional pressure gradient)
C. Pw (Mean coronary wedge pressure)
Why was FFR developed as an alternative to coronary flow reserve (CFR)?
A. CFR was found to be highly specific for epicardial stenosis severity
B. CFR did not correlate well with angiographic narrowing in human studies
C. CFR measurements required invasive Doppler probes
D. FFR provides an assessment of the microvascular bed
B. CFR did not correlate well with angiographic narrowing in human studies
Why can a normal CFR not exclude a stenosis as the cause of reduced flow?
A. CFR does not account for microvascular disease
B. CFR does not measure coronary pressure directly
C. CFR only evaluates collateral circulation
D. CFR is only valid in animal models
A. CFR does not account for microvascular disease
Which of the following pressures is subtracted from both Pa and Pd in the FFRmyo calculation?
A. Pw (Coronary wedge pressure)
B. Pv (Mean right atrial pressure)
C. ΔP (Mean translesional pressure gradient)
D. Systolic blood pressure
B. Pv (Mean right atrial pressure)
What is the primary advantage of FFR over CFR?
A. FFR isolates the effect of epicardial stenosis independent of microvascular disease
B. FFR measures both coronary flow and myocardial perfusion
C. FFR is non-invasive and can be obtained from CT scans
D. FFR eliminates the need for maximal hyperemia during assessment
A. FFR isolates the effect of epicardial stenosis independent of microvascular disease
What is NOT a major goal of intravascular lesion assessment tools?
A. Avoiding unnecessary revascularization procedures
B. Improving PCI outcomes in CAD patients
C. Diagnosing microvascular dysfunction in patients with CAD
D. Identifying hemodynamically significant coronary stenoses
C (The goal is to diagnose microvascular dysfunction in patients with symptoms but no CAD.)
Why is coronary angiography limited in assessing the hemodynamic significance of a lesion?
A. It cannot measure blood flow directly
B. It is a two-dimensional representation of a three-dimensional structure
C. It does not provide plaque composition details
D. All of the above
D. All of the above
In which stenosis range is coronary angiography particularly unreliable?
A. Less than 30%
B. 30% to 80%
C. Greater than 90%
D. Only total occlusions
B. 30% to 80%
Which of the following is NOT an artifact that interferes with lesion interpretation in angiography?
A. Contrast streaming
B. Vessel foreshortening
C. Branch overlap
D. Myocardial perfusion imaging
D. Myocardial perfusion imaging
What is NOT a major goal of intravascular lesion assessment tools?
A. Avoiding unnecessary revascularization procedures
B. Improving long-term PCI outcomes in CAD patients
C. Diagnosing microvascular dysfunction in patients without CAD
D. Measuring blood pressure in the pulmonary arteries
D. Measuring blood pressure in the pulmonary arteries
Why is coronary angiography limited in assessing the hemodynamic significance of stenoses?
A. It only provides a two-dimensional view of a three-dimensional structure
B. It cannot differentiate between diffusely diseased and normal vessel segments
C. It does not provide information on plaque composition
D. All of the above
D. All of the above
What range of stenosis severity is most challenging for coronary angiography to assess?
A. Less than 10%
B. 10%–30%
C. 30%–80%
D. Greater than 90%
C. 30%–80%
Which of the following is NOT a limitation of coronary angiography?
A. Inability to determine plaque composition
B. Potential for ambiguous lesion interpretation due to artifacts
C. Poor correlation with stress testing and translesional physiology
D. Direct measurement of myocardial blood flow
D. Direct measurement of myocardial blood flow
Which intravascular imaging techniques can provide detailed information on plaque composition?
A. IVUS and OCT
B. Coronary angiography alone
C. ECG and echocardiography
D. Pulse oximetry and Doppler ultrasound
A. IVUS and OCT
Which of the following angiographic artifacts can interfere with lesion interpretation?
A. Contrast streaming
B. Vessel foreshortening
C. Branch overlap
D. All of the above
D. All of the above
Why can an eccentric lesion appear different when viewed from various angles?
A. The contrast dye enhances different segments at different times
B. The shape of the lumen can look larger or smaller depending on the viewing angle
C. The guidewire placement alters the appearance of the lesion
D. The lesion composition changes dynamically during angiography
B. The shape of the lumen can look larger or smaller depending on the viewing angle
What is a major advantage of intravascular imaging over angiography?
A. It provides detailed information about plaque characteristics
B. It eliminates the need for contrast dye
C. It is completely non-invasive
D. It replaces the need for functional assessments like FFR
A. It provides detailed information about plaque characteristics
Which pharmacologic agent is most commonly used to induce maximal coronary hyperemia for FFR measurement?
A. Nitroprusside (NTP)
B. Papaverine
C. Regadenoson
D. Adenosine
D. Adenosine
What is the primary advantage of IV adenosine over intracoronary (IC) administration?
A. It is weight-based and provides a sustained hyperemic stimulus
B. It has a longer half-life than other agents
C. It causes less fluctuation in pressure readings
D. It does not cause a drop in blood pressure
A. It is weight-based and provides a sustained hyperemic stimulus
Which of the following is a known disadvantage of IV adenosine?
A. Increased heart rate (↑HR)
B. Atrioventricular (AV) block and hypotension
C. Potential for torsades de pointes
D. Unpredictable onset of action
B. Atrioventricular (AV) block and hypotension
Why is IV adenosine preferred for assessing ostial lesions and pressure pullbacks?
A. It allows for a slow pullback to identify pressure drops across serial lesions
B. It has a shorter duration of action compared to intracoronary administration
C. It prevents all fluctuations in pressure readings
D. It eliminates the need for coronary angiography
A. It allows for a slow pullback to identify pressure drops across serial lesions
Which hyperemic agent has the longest duration of action?
A. Adenosine (IV)
B. Papaverine
C. Regadenoson
D. Nitroprusside (NTP
C. Regadenoson
What is the purpose of determining the “smart minimum” FFR value during IV adenosine infusion?
A. It ensures the highest possible FFR value is recorded
B. It identifies the lowest Pd/Pa without pressure wave artifacts
C. It reduces the need for repeat FFR measurements
D. It accounts for the effects of coronary microvascular disease
B. It identifies the lowest Pd/Pa without pressure wave artifacts
Which of the following hyperemic agents is administered via intracoronary (IC) injection?
A. Regadenoson
B. Papaverine
C. IV Adenosine
D. None of the above
B. Papaverine
What is a potential disadvantage of using nitroprusside (NTP) for inducing hyperemia?
A. Increased heart rate
B. Potential for torsades de pointes
C. Hypotension
D. Long duration of action
C. Hypotension
Which of the following statements is true regarding IC and IV adenosine for FFR measurement?
A. IV adenosine is more accurate than IC adenosine
B. IC adenosine is equivalent to IV adenosine for FFR determination
C. IC adenosine cannot achieve maximal hyperemia
D. IV adenosine is no longer used for FFR measurement
B. IC adenosine is equivalent to IV adenosine for FFR determination
What was the landmark trial that demonstrated the clinical benefits of FFR-guided PCI?
A. COURAGE
B. SYNTAX
C. FAME
D. ISCHEMIA
C. FAME
What is the optimal IC adenosine dose for inducing maximal hyperemia in the left coronary artery (LCA)?
A. 10–50 mcg
B. 50–100 mcg
C. 100–200 mcg
D. 250–500 mcg
C. 100–200 mcg
At what IC adenosine dose does heart block occur in more than 10% of patients when administered in the right coronary artery (RCA)?
A. Less than 10 mcg
B. 10–30 mcg
C. More than 50 mcg
D. 200 mcg
C. More than 50 mcg
What is the recommended concentration of IC adenosine for FFR measurement?
A. 1–5 mcg/mL
B. 10–30 mcg/mL
C. 50–100 mcg/mL
D. 100–200 mcg/mL
B. 10–30 mcg/mL
Why has there been a renewed interest in using IC adenosine instead of IV adenosine?
A. IC adenosine is more effective at inducing hyperemia
B. Hemodynamic variability has been observed with IV adenosine
C. IC adenosine is less expensive and easier to administer
D. IV adenosine is no longer available for clinical use
B. Hemodynamic variability has been observed with IV adenosine
What is a practical advantage of preparing a 1-liter adenosine/saline mix in the cath lab?
A. It eliminates the need for IV infusion pumps
B. It provides a consistent concentration for the entire lab’s procedures
C. It reduces the risk of heart block in all patients
D. It eliminates the need for hyperemia during FFR measurements
B. It provides a consistent concentration for the entire lab’s procedures
How is IC adenosine typically administered in the cath lab?
A. Through an IV infusion pump
B. Using a stopcock and flush syringe setup
C. As a continuous intracoronary infusion
D. Through a microcatheter
B. Using a stopcock and flush syringe setup
Why must FFR be measured during minimal and stable coronary resistance?
A. To ensure the measurement is taken during systole
B. To maintain linearity between pressure and coronary flow ratios
C. To prevent microvascular disease from affecting the measurement
D. To eliminate the need for hyperemic agents
B. To maintain linearity between pressure and coronary flow ratios
What did Sen et al. identify using wave intensity analysis?
A. The importance of measuring FFR at peak systole
B. A specific period in diastole with minimal wave interference
C. A new pharmacologic agent for inducing hyperemia
D. A new imaging technique superior to FFR
B. A specific period in diastole with minimal wave interference
What is the term for the diastolic period when reflected pressure waves are quiescent?
A. Fractional flow period
B. Hyperemic phase
C. Wave-free period (WFP)
D. Myocardial relaxation phase
C. Wave-free period (WFP)
What is the physiological basis for iFR measurement?
A. It is measured during maximal hyperemia
B. It assesses coronary flow reserve rather than pressure ratios
C. It measures Pd/Pa during the wave-free period at rest
D. It requires microvascular resistance calculations
C. It measures Pd/Pa during the wave-free period at rest
What is the correlation coefficient (r) between iFR and FFR?
A. 0.70
B. 0.80
C. 0.90
D. 1.00
C. 0.90
What is the generally accepted iFR threshold for making treatment decisions?
A. 0.75
B. 0.80
C. 0.85
D. 0.89
D. 0.89
What was the approximate overall concordance between iFR and FFR in clinical studies?
A. 60%
B. 70%
C. 80%–85%
D. 95%–100%
C. 80%–85%
Which two major outcome studies validated iFR as an alternative to FFR?
A. SYNTAX and COURAGE
B. DEFINE-FLAIR and iFR-SWEDEHEART
C. ISCHEMIA and FAME
D. ORBITA and DANAMI-3
B. DEFINE-FLAIR and iFR-SWEDEHEART
What does dPR measure?
A. The lowest Pd/Pa during the entire cardiac cycle
B. The average Pd/Pa during the entire diastole
C. The Pd/Pa ratio only at peak systole
D. The pressure gradient across a stenosis during hyperemia
B. The average Pd/Pa during the entire diastole
Which of the following NHPRs is defined as the lowest filtered mean Pd/Pa during the entire cardiac cycle?
A. iFR
B. dPR
C. DFR
D. RFR
D. RFR
What is the ischemic threshold for resting Pd/Pa used in most comparative clinical studies?
A. 0.75
B. 0.80
C. 0.89
D. 0.92
D. 0.92
How does dPR compare with iFR?
A. dPR is numerically equivalent to iFR
B. dPR is significantly lower than iFR
C. dPR is only useful during hyperemia
D. dPR is superior to iFR in all clinical applications
A. dPR is numerically equivalent to iFR
What is the main limitation of Pd/Pa as an NHPR?
A. It requires adenosine for accurate measurements
B. It is not widely available in clinical practice
C. It has lower reproducibility and higher susceptibility to hemodynamic variability compared with FFR
D. It does not correlate with iFR or other NHPRs
C. It has lower reproducibility and higher susceptibility to hemodynamic variability compared with FFR
Which algorithm helps delineate the diastolic period for dPR calculations?
A. dP/dt curve of the aortic pressure
B. Smart minimum Pd/Pa tracking
C. Continuous wave Doppler assessment
D. Coronary wedge pressure analysis
A. dP/dt curve of the aortic pressure
Which NHPR is defined as the average Pd/Pa during Pa less than mean Pa with a negative slope?
A. dPR
B. DFR
C. RFR
D. FFR
B. DFR
Why do NHPRs like Pd/Pa have higher ischemic thresholds compared with FFR?
A. They are measured at rest rather than during hyperemia
B. They use different pressure sensors
C. They require contrast injection for accurate results
D. They incorporate microvascular resistance calculations
A. They are measured at rest rather than during hyperemia
