{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T17:06:29Z","timestamp":1754154389247,"version":"3.41.2"},"reference-count":29,"publisher":"Wiley","issue":"13","license":[{"start":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T00:00:00Z","timestamp":1751241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Physiological Reports"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>A significant proportion of stenoses have an abnormal fractional flow reserve (FFR) after angiographically successful percutaneous coronary intervention (PCI), which is traditionally attributed to differences in coronary flow velocity reserve (CFVR) or hyperemic microvascular resistance (hMR). This study investigated the mechanisms underlying residual low FFR despite good angiographic results and normalized hyperemic stenosis resistance (hSR) using wave\u2010intensity analysis (WIA), which evaluates phasic characteristics of cardiac\u2010coronary coupling. Sixty\u2010three vessels from patients who underwent PCI for stable intermediate stenoses were included. Peri\u2010PCI characteristics of conventional and WIA parameters were assessed. Ten (16%) vessels exhibited residual low FFR (\u22640.8) despite normalized hSR (&lt;0.8), without significant differences in hyperemic flow (velocity) (hAPV), CFVR, or hMR compared with concordant normal FFR\u2010hSR group (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05). WIA revealed a significantly slower (peak\u2010time of backward expansion wave, tBEW<jats:sub>peak<\/jats:sub>\u2009=\u200920%\u2009\u00b1\u20096% vs. 29%\u2009\u00b1\u200917% of expansion period, <jats:italic>p<\/jats:italic>\u2009=\u20090.005) and weaker (BEW<jats:sub>peak<\/jats:sub>\u2009=\u200910.1\u2009\u00b1\u20098.9 vs. 15.8\u2009\u00b1\u200911.4 10.kW.m\u20102.s\u20102, <jats:italic>p<\/jats:italic>\u2009=\u20090.045) impact of microvascular suction responsible for diastolic coronary filling during hyperemia in the low FFR group, despite comparable pre\u2010PCI characteristics. Residual low FFR after PCI may reflect altered cardiac\u2010coronary coupling without limitation of flow or vasodilator capacity when the blunted impact of accelerating wave energy flux with delayed coronary filling fails to sustain distal pressure. The influence of cardiac\u2010coronary coupling on post\u2010PCI FFR warrants further investigation.<\/jats:p>","DOI":"10.14814\/phy2.70440","type":"journal-article","created":{"date-parts":[[2025,6,30]],"date-time":"2025-06-30T23:09:54Z","timestamp":1751324994000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Altered cardiac\u2010coronary coupling relates to abnormal fractional flow reserve without flow limitation after percutaneous coronary interventions"],"prefix":"10.14814","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1944-2576","authenticated-orcid":false,"given":"Ahmet","family":"Tas","sequence":"first","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences  Amsterdam the Netherlands"},{"name":"Emergency Department Gomec State Hospital  Balikesir Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alp","family":"Ozcan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Istanbul University  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yaren","family":"Alan","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Istanbul University  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabahattin","family":"Umman","sequence":"additional","affiliation":[{"name":"Department of Cardiology Istanbul University  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kim H.","family":"Parker","sequence":"additional","affiliation":[{"name":"Department of Bioengineering Imperial College  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tim P.","family":"van de Hoef","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Center Utrecht  Utrecht the Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9614-1614","authenticated-orcid":false,"given":"Murat","family":"Sezer","sequence":"additional","affiliation":[{"name":"Department of Cardiology Acibadem International Hospital  Istanbul Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan J.","family":"Piek","sequence":"additional","affiliation":[{"name":"Department of Cardiology Amsterdam UMC, Heart Centre, Amsterdam Cardiovascular Sciences  Amsterdam the 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