TY - CHAP
T1 - Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans
T2 - Comparison with pressure wire - fractional flow reserve
AU - Papafaklis, Michail I.
AU - Muramatsu, Takashi
AU - Ishibashi, Yuki
AU - Lakkas, Lampros S.
AU - Nakatani, Shimpei
AU - Bourantas, Christos V.
AU - Ligthart, Jurgen
AU - Onuma, Yoshinobu
AU - Echavarria-Pinto, Mauro
AU - Tsirka, Georgia
AU - Kotsia, Anna
AU - Nikas, Dimitrios N.
AU - Mogabgab, Owen
AU - Van Geuns, Robert Jan
AU - Naka, Katerina K.
AU - Fotiadis, Dimitrios I.
AU - Brilakis, Emmanouil S.
AU - Garcia-Garcia, Héctor M.
AU - Escaned, Javier
AU - Zijlstra, Felix
AU - Michalis, Lampros K.
AU - Serruys, Patrick W.
PY - 2014/9/1
Y1 - 2014/9/1
N2 - Aims: To develop a simplified approach of virtual functional assessment of coronary stenosis from routine angiographic data and test it against fractional flow reserve using a pressure wire (wire-FFR).Methods and results: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by wire-FFR (reference standard: .0.80). The 3D-QCA models were processed with computational fluid dynamics (CFD) to calculate the lesion-specific pressure gradient (?¢P) and construct the ?¢P.flow curve, from which the virtual functional assessment index (vFAI) was derived. The discriminatory power of vFAI for ischaemia-producing lesions was high (area under the receiver operator characteristic curve [AUC]: 92% [95% CI: 86-96%]). Diagnostic accuracy, sensitivity and specificity for the optimal vFAI cut-point (.0.82) were 88%, 90% and 86%, respectively. Virtual-FAI demonstrated superior discrimination against 3D-QCA.derived % area stenosis (AUC: 78% [95% CI: 70-84%]; p<0.0001 compared to vFAI). There was a close correlation (r=0.78, p<0.0001) and agreement of vFAI compared to wire-FFR (mean difference: .0.0039?}0.085, p=0.59).Conclusions: We developed a fast and simple CFD-powered virtual haemodynamic assessment model using only routine angiography and without requiring any invasive physiology measurements/hyperaemia induction. Virtual-FAI showed a high diagnostic performance and incremental value to QCA for predicting wire-FFR; this ?gless invasive?h approach could have important implications for patient management and cost.
AB - Aims: To develop a simplified approach of virtual functional assessment of coronary stenosis from routine angiographic data and test it against fractional flow reserve using a pressure wire (wire-FFR).Methods and results: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by wire-FFR (reference standard: .0.80). The 3D-QCA models were processed with computational fluid dynamics (CFD) to calculate the lesion-specific pressure gradient (?¢P) and construct the ?¢P.flow curve, from which the virtual functional assessment index (vFAI) was derived. The discriminatory power of vFAI for ischaemia-producing lesions was high (area under the receiver operator characteristic curve [AUC]: 92% [95% CI: 86-96%]). Diagnostic accuracy, sensitivity and specificity for the optimal vFAI cut-point (.0.82) were 88%, 90% and 86%, respectively. Virtual-FAI demonstrated superior discrimination against 3D-QCA.derived % area stenosis (AUC: 78% [95% CI: 70-84%]; p<0.0001 compared to vFAI). There was a close correlation (r=0.78, p<0.0001) and agreement of vFAI compared to wire-FFR (mean difference: .0.0039?}0.085, p=0.59).Conclusions: We developed a fast and simple CFD-powered virtual haemodynamic assessment model using only routine angiography and without requiring any invasive physiology measurements/hyperaemia induction. Virtual-FAI showed a high diagnostic performance and incremental value to QCA for predicting wire-FFR; this ?gless invasive?h approach could have important implications for patient management and cost.
KW - Computational fluid dynamics
KW - Fractional flow reserve
KW - Functional assessment
KW - Quantitative coronary angiography
UR - http://www.scopus.com/inward/record.url?scp=84907562874&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907562874&partnerID=8YFLogxK
U2 - 10.4244/EIJY14M07_01
DO - 10.4244/EIJY14M07_01
M3 - Chapter
C2 - 24988003
AN - SCOPUS:84907562874
VL - 10
SP - 574
EP - 583
BT - EuroIntervention
PB - EuroPCR
ER -