Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve

Michail I. Papafaklis, Takashi Muramatsu, Yuki Ishibashi, Christos V. Bourantas, Dimitrios I. Fotiadis, Emmanouil S. Brilakis, Héctor M. Garcia-Garcia, Javier Escaned, Patrick W. Serruys, Lampros K. Michalis

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Methods: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. Results: The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (p. <. 0.001) versus 3D-QCA %area stenosis (AUC: 77.5% [95% CI: 69.8-85.3%]). There was a good correlation between virtual resting Pd/Pa and FFR (r = 0.69, p. <. 0.001). Conclusions: Virtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice.

Original languageEnglish (US)
JournalHeart Lung and Circulation
DOIs
StateAccepted/In press - Sep 15 2016

Fingerprint

Coronary Angiography
Pressure
Area Under Curve
Hyperemia
Hydrodynamics
Routine Diagnostic Tests
Arterial Pressure
Pathologic Constriction
Sensitivity and Specificity

Keywords

  • Computational flow dynamics
  • Coronary stenoses
  • Fractional flow reserve
  • Functional assessment
  • Haemodynamics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling : Diagnostic Performance Against Fractional Flow Reserve. / Papafaklis, Michail I.; Muramatsu, Takashi; Ishibashi, Yuki; Bourantas, Christos V.; Fotiadis, Dimitrios I.; Brilakis, Emmanouil S.; Garcia-Garcia, Héctor M.; Escaned, Javier; Serruys, Patrick W.; Michalis, Lampros K.

In: Heart Lung and Circulation, 15.09.2016.

Research output: Contribution to journalArticle

Papafaklis, MI, Muramatsu, T, Ishibashi, Y, Bourantas, CV, Fotiadis, DI, Brilakis, ES, Garcia-Garcia, HM, Escaned, J, Serruys, PW & Michalis, LK 2016, 'Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve', Heart Lung and Circulation. https://doi.org/10.1016/j.hlc.2017.03.163
Papafaklis, Michail I. ; Muramatsu, Takashi ; Ishibashi, Yuki ; Bourantas, Christos V. ; Fotiadis, Dimitrios I. ; Brilakis, Emmanouil S. ; Garcia-Garcia, Héctor M. ; Escaned, Javier ; Serruys, Patrick W. ; Michalis, Lampros K. / Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling : Diagnostic Performance Against Fractional Flow Reserve. In: Heart Lung and Circulation. 2016.
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abstract = "Background: Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Methods: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. Results: The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5{\%} [95{\%} CI: 85.4-95.6{\%}]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9{\%}, 90.4{\%} and 81.6{\%}, respectively. Virtual resting Pd/Pa demonstrated superior performance (p. <. 0.001) versus 3D-QCA {\%}area stenosis (AUC: 77.5{\%} [95{\%} CI: 69.8-85.3{\%}]). There was a good correlation between virtual resting Pd/Pa and FFR (r = 0.69, p. <. 0.001). Conclusions: Virtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice.",
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T1 - Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling

T2 - Diagnostic Performance Against Fractional Flow Reserve

AU - Papafaklis, Michail I.

AU - Muramatsu, Takashi

AU - Ishibashi, Yuki

AU - Bourantas, Christos V.

AU - Fotiadis, Dimitrios I.

AU - Brilakis, Emmanouil S.

AU - Garcia-Garcia, Héctor M.

AU - Escaned, Javier

AU - Serruys, Patrick W.

AU - Michalis, Lampros K.

PY - 2016/9/15

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N2 - Background: Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Methods: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. Results: The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (p. <. 0.001) versus 3D-QCA %area stenosis (AUC: 77.5% [95% CI: 69.8-85.3%]). There was a good correlation between virtual resting Pd/Pa and FFR (r = 0.69, p. <. 0.001). Conclusions: Virtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice.

AB - Background: Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Methods: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. Results: The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4-95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (p. <. 0.001) versus 3D-QCA %area stenosis (AUC: 77.5% [95% CI: 69.8-85.3%]). There was a good correlation between virtual resting Pd/Pa and FFR (r = 0.69, p. <. 0.001). Conclusions: Virtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice.

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KW - Fractional flow reserve

KW - Functional assessment

KW - Haemodynamics

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