ArticleAsiaIntervention2026
Haemodynamic predictors of lesion progression in non-ischaemic tandem coronary stenoses.
Article in AsiaIntervention, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Background: Tandem coronary stenoses pose diagnostic challenges due to complex flow interactions that can obscure lesion severity when using traditional pressure-based indices such as fractional flow reserve (FFR). Computational fluid dynamics (CFD) can offer a detailed alternative haemodynamic assessment, but its prognostic value in non-haemodynamically significant tandem lesions remains unclear. Aims: We aimed to evaluate whether CFD-derived haemodynamic parameters could predict the 12-month progression of initially non-significant tandem lesions in the left anterior descending artery (LAD), defined by computed tomography (CT)-derived FFR (FFR-CT) >=0.80. Methods: In a retrospective cohort of 60 1:1 propensity score-matched patients with tandem LAD stenoses, baseline and 12-month follow-up coronary CT angiography were performed. FFR-CT was computed using patient-specific CFD simulations, where FFR was defined as the ratio of the mean distal to aortic pressure under simulated hyperaemic flow conditions. CFD simulations quantified the time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). Lesion progression was defined as diameter stenosis >70% and/or FFR-CT <0.80 at follow-up. Results: Baseline CT-derived FFR did not differ significantly between groups. Patients with lesion progression (n=30) exhibited significantly lower baseline TAWSS (0.32±0.10 Pa vs 0.82±0.20 Pa; p<0.001), higher OSI (0.22±0.06 vs 0.05±0.03; p<0.001), and prolonged RRT (1.9±0.6 s vs 0.7±0.3 s; p<0.001) compared with those with stable lesions. Multivariate analysis confirmed TAWSS, OSI, RRT, age, and diabetes as independent predictors of progression. Conclusions: CFD-derived haemodynamic profiles strongly predict the 12-month progression of tandem LAD lesions despite a non-ischaemic baseline FFR-CT. The integration of CFD parameters with conventional physiology may improve the management of tandem coronary lesions beyond pressure-based indices alone.
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