scholarly journals Accuracy and reproducibility of fast fractional flow reserve computation from invasive coronary angiography

2017 ◽  
Vol 33 (9) ◽  
pp. 1305-1312 ◽  
Author(s):  
A. R. van Rosendael ◽  
G. Koning ◽  
A. C. Dimitriu-Leen ◽  
J. M. Smit ◽  
J. M. Montero-Cabezas ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Fractional Flow ◽  
Flow Reserve

Referral of patients for fractional flow reserve using quantitative flow ratio

2018 ◽  
Vol 20 (11) ◽  
pp. 1231-1238 ◽  
Author(s):  
Jeff M Smit ◽  
Gerhard Koning ◽  
Alexander R van Rosendael ◽  
Mohammed El Mahdiui ◽  
Bart J Mertens ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Quantitative Coronary Angiography ◽  
Coronary Intervention ◽  
Flow Ratio ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Abstract Aims Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. Methods and results Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to ‘no referral’ (QFR ≥0.86), referral for ‘FFR’ (QFR 0.78–0.85), or ‘direct PCI’ (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the ‘no referral’ group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. Conclusion QFR is feasible to use for the selection of patients for FFR referral.

scholarly journals Feasibility of virtual fractional flow reserve derived from coronary angiography and its correlation with invasive functional assessment

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Mano ◽  
V Ferreira ◽  
R Ramos ◽  
E Oliveira ◽  
A Santana ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Functional Assessment ◽  
Invasive Coronary Angiography ◽  
Area Under The Curve ◽  
Fractional Flow ◽  
Predictive Values ◽  
Flow Reserve ◽  
Tertiary Center

Abstract Introduction Invasive functional assessment (iFA) of coronary artery disease (CAD) needs expensive devices, has potential procedure-related complications and is still underutilized. Virtual Fractional Flow Reserve (vFFR) derived from invasive coronary angiography (ICA) has the potential to overcome these limitations. Purpose To investigate the feasibility of vFFR analysis and its correlation with iFA (iFR, RFR or FFR). Methods Retrospective analysis of consecutive patients (pts) who underwent iFA in a tertiary center between 2019 and 2020. vFFR was calculated using a dedicated software (CAAS Workstation 8.4) based on standard non-hyperaemic coronary angiograms acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance and accuracy of vFFR were evaluated. vFFR was considered positive when <0.80. FFR <0.8 and iFR/RFR <0.90 were classified as positive according to current clinical standards. Results Out of 113 coronary arteries of 102 pts, vFFR was successfully analysed in 106 (94%). Reasons for vFFR analysis failure were: vessel projection overlap (48%), <2 angiographic projections (28%) and table movement while acquisition (24%). From 106 coronary arteries of 95 pts with analysable vFFR (78% male, mean age 67.8±9.7 years), 90 (85%) showed agreement with the respective iFA result. The vFFR predicted which lesions were physiologically significant and which were not with accuracy, sensitivity, specificity, positive and negative predictive values of 73%, 73%, 83%, 53%, and 92% respectively. The mean difference between vFFR and iFA were −0.0484±0.096 and Pearson's correlation coefficient was 0.533 (p<0.001). The ROC area under the curve was 0.839 (0.751–0.928, p<0.001). Conclusion FFR were feasible in 94% of cases analysed retrospectively. As compared to gold-standard iFA, vFFR had an overall moderate accuracy in detecting ischemia-producing lesions and a negative predictive value >90%. vFFR has the potential to substantially simplify physiological coronary lesion assessment and thus improve its current uptake. FUNDunding Acknowledgement Type of funding sources: None. Bland-Altman plot between vFFR and IFA

scholarly journals Virtual fractional flow reserve derived from coronary angiography – artery and lesion specific correlations

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Mano ◽  
V Ferreira ◽  
R Ramos ◽  
P Bras ◽  
J Reis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
False Negative ◽  
Lesion Site ◽  
Fractional Flow ◽  
Coronary Syndrome ◽  
Flow Reserve ◽  
Tertiary Center

Abstract Introduction Virtual Fractional flow reserve (vFFR) from standard non-hyperaemic invasive coronary angiography (ICA) has emerged as a promising non-invasive test to assess hemodynamic severity of coronary artery disease (CAD). Purpose To investigate the difference in vFFR analysis between vessels and specific lesions. Methods Retrospective analysis of consecutive patients (pts) who underwent invasive functional assessment (iFA) in a tertiary center between 2019 and 2020. vFFR was calculated using dedicated software (CAAS Workstation 8.4) based on coronary angiograms of the acquired in ≥2 different projections, by operators blinded to iFA results. Diagnostic performance of vFFR was evaluated and correlated with iFA, according to coronary vessel, vessel diameter at stenosis, diameter stenosis and area stenosis at lesion. vFFR was considered positive when <0.80. FFR <0.8 and iFR/RFR <0.90 were classified as positive according to current clinical standards. Results 106 coronary arteries of 95 pts (78% male, mean age 67.8±9.7 years) underwent vFFR evaluation. ICA indications were chronic coronary syndrome in 63% or acute coronary syndrome (non-culprit lesion) in the remaining pts. VFFR accuracy was good (AUC 0.839 (p<0.001) and Pearson's correlation coefficient 0.533 (p<0.001) when vFFR was measured in the distal vessel segment. The correlation improved when vFFR were assessed at lesion site (r=0.631, p<0.001) or up to 1cm below the stenosis (0.610, p<0.001). Binary concordance of 89% were observed in RCA and LAD (Sensibility -S 68%, Specificity-Sp 96%, False positive -FP 3.8%, False negative - FN 31%, predictive positive value-PPV 87%, predictive negative value- PNV 89%), while in the circumflex coronary artery binary concordance were of 77% (S 50%; Sp 82%; FP 18%; FN 50%; PPV 33% and PNV 90%). Correlation between vFFR and iFA was higher in vessels ≥2mm (r=0.730, p<0.001). and in lesions in the extremes of the severity spectrum (Table 1). Conclusion vFFR has a moderate to high linear correlation to iFA, depending on the artery and type of lesion studied. The higher correlation was found when vFFR were measured at lesion site, in non-circumflex artery stenosis, in vessels ≥2mm and in vessels with mild or severe stenosis. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Real world utilization of CT derived fractional flow reserve in stable angina from contemporary practice: impact on downstream utilization of invasive coronary angiogram and clinical decision making

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Ray ◽  
K Green ◽  
A Shamsi ◽  
A Mahmood ◽  
A Hatrick ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Invasive Coronary Angiography ◽  
Severe Disease ◽  
Fractional Flow ◽  
Coronary Cta ◽  
Flow Reserve ◽  
Artery Disease

Abstract   Background/Introduction - Fractional flow reserve (FFR), a pressure wire-based index used during coronary angiography to assess the severity of potential coronary stenosis, is considered as the reference standard for evaluating the severity of stenosis in coronary artery disease (CAD). Recently, computed tomography angiography-derived fractional flow reserve (FFRct) has been recommended for evaluating functional severity of stenoses as it improves diagnostic accuracy and reduces the need for invasive coronary angiography. Purpose To determine whether non-invasive FFRct predicts severity of coronary artery disease and whether its addition improves efficiency of proceeding to revascularisation and invasive coronary angiography (ICA) compared to coronary computed tomography angiography (CTA) without FFR. Methods This observational retrospective single center study included two cohorts of patients who presented in a District General Hospital in UK. The first group consisted of all patients who underwent coronary CTA for chest pain from January 2013 to December 2014. The second cohort consisted of all patients who proceeded to have measurement of FFRct from April 2018 to June 2019 after routine coronary CTA for chest pain. The two groups showed similar demographics. FFRct was analysed using the software HeartFlow. We determined the agreement of FFRct (positive if <0.80) with stenosis on CTA and ICA (positive if >50% left main or >70% other coronary artery) and whether it correlated with need for revascularisation. We also assessed if adding FFRct <0.80 improved efficiency of referral to ICA, defined as decreased diagnosis of mild or moderate stenosis (<70%) and higher yield of severe disease (>70%). The two cohorts were compared to determine the above specific end-points. Results In the first cohort, data was collected for 915 patients. 240 (26.2%) of these patients proceeded to ICA, which showed severe disease in 31 (3.3%) patients needing revascularisation. In the second cohort of patients, 824 patients underwent coronary CTA and 201 (24.4%) proceeded to have FFRct measurements. 99 (49%) of these patients had a negative FFR and 65 (32%) patients had a positive result (<0.80). There was agreement between FFRct and invasive coronary angiography/stress echo in 44 (77%) patients, with regards to severity /revascularisation. The need for ICA was significantly reduced if coronary CTA and FFRct were both done (240/915; 26.2% vs 54/824; 6.5%: p value <0.00001). Conclusion Reserving ICA for patients with a positive FFRct (<0.80) could reduce the number of ICA after coronary CTA and augment the number of ICA leading to revascularisation. Use of FFRct as a gatekeeper to ICA will improve appropriate selection of patients referred and this in-turn will reduce the burden of complications associated with invasive procedures, reduce costs and ensure better utilization of Cath-lab resources. Funding Acknowledgement Type of funding source: None

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