scholarly journals The relationship between coronary stenosis morphology and fractional flow reserve: a computational fluid dynamics modelling study

2021 ◽  
Author(s):  
Roberto T F Newcombe ◽  
Rebecca C Gosling ◽  
Vignesh Rammohan ◽  
Patricia V Lawford ◽  
D Rodney Hose ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Computational Modelling ◽  
Fractional Flow ◽  
Cfd Modelling ◽  
Flow Reserve ◽  
The Relationship ◽  
Lesion Severity

Abstract Background International guidelines mandate the use of fractional flow reserve (FFR) and/or non-hyperaemic pressure ratios to assess the physiological significance of moderate coronary artery lesions to guide revascularisation decisions. However, they remain underused such that visual estimation of lesion severity continues to be the predominant decision-making tool. It would be pragmatic to have an improved understanding of the relationship between lesion morphology and haemodynamics. Aims To compute virtual FFR (vFFR) in idealised coronary artery geometries with a variety of stenosis and vessel characteristics Methods Coronary artery geometries were modelled, based upon physiologically realistic branched arteries. Common stenosis characteristics were studied, including % narrowing, length, eccentricity, shape, number, position relative to branch, and distal (myocardial) resistance. Computational fluid dynamics (CFD) modelling was used to calculate vFFRs using the VIRTUheartTM system. Results Percentage lesion severity had the greatest effect upon FFR. Any ≥80% diameter stenosis in two views (i.e. concentric) was physiologically significant (FFR ≤ 0.80), irrespective of length, shape or vessel diameter. Almost all eccentric stenoses and all 50% concentric stenoses were physiologically non-significant, whilst 70% uniform concentric stenoses about 10mm long straddled the ischaemic threshold (FFR 0.80). A low microvascular resistance (MVR) reduced FFR on average by 0.05, and a high MVR increased it by 0.03. Conclusions Using computational modelling, we have produced an analysis of virtual FFR that relates stenosis characteristics to haemodynamic significance. The strongest predictor of a positive virtual FFR was a concentric, ≥80% diameter stenosis. The importance of MVR was quantified. Other lesion characteristics have a limited impact.

scholarly journals Fractional Flow Reserve Derived from Coronary Imaging and Computational Fluid Dynamics

2014 ◽  
Vol 9 (3) ◽  
pp. 145 ◽  
Author(s):  
Ioannis Pantos ◽  
Demosthenes Katritsis ◽  
◽  
Keyword(s):  
Fluid Dynamics ◽  
Coronary Artery Disease ◽  
Computational Fluid Dynamics ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Artery Cannulation ◽  
Flow Reserve ◽  
Artery Disease

The assessment of functional severity of atherosclerotic stenoses in patients with coronary artery disease by invasive fractional flow reserve (FFR) measurement requires coronary artery cannulation, advancement of a wire and intravenous adenosine infusion with inherent procedure-related risk and costs. Coronary computed tomographic angiography (CCTA) and rotational coronary angiography (RA) have been recently used in conjunction with computational fluid dynamics (CFD) and image-based modelling for the determination of FFR without the need for additional imaging, modification of acquisition protocols or administration of medication. FFR derived from CCTA was demonstrated as superior to measures of CCTA stenosis severity for determination of lesion-specific ischaemia. Estimation of FFR from RA images and CFD provides a less invasive alternative to conventional FFR measurement while estimated values are in agreement with measured values. These new, combined anatomic–functional assessments have the potential to simplify the noninvasive diagnosis of coronary artery disease with a single study to identify patients with ischaemia-causing stenosis who may benefit from revascularisation.

scholarly journals Accuracy of computational pressure-fluid dynamics applied to coronary angiography to derive fractional flow reserve: FLASH FFR

2019 ◽  
Vol 116 (7) ◽  
pp. 1349-1356 ◽  
Author(s):  
Jianping Li ◽  
Yanjun Gong ◽  
Weimin Wang ◽  
Qing Yang ◽  
Bin Liu ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Diagnostic Performance ◽  
Characteristic Curve ◽  
Fractional Flow ◽  
Performance Goal ◽  
Flow Reserve

Abstract Aims Conventional fractional flow reserve (FFR) is measured invasively using a coronary guidewire equipped with a pressure sensor. A non-invasive derived FFR would eliminate risk of coronary injury, minimize technical limitations, and potentially increase adoption. We aimed to evaluate the diagnostic performance of a computational pressure-flow dynamics derived FFR (caFFR), applied to coronary angiography, compared to invasive FFR. Methods and results The FLASH FFR study was a prospective, multicentre, single-arm study conducted at six centres in China. Eligible patients had native coronary artery target lesions with visually estimated diameter stenosis of 30–90% and diagnosis of stable or unstable angina pectoris. Using computational pressure-fluid dynamics, in conjunction with thrombolysis in myocardial infarction (TIMI) frame count, applied to coronary angiography, caFFR was measured online in real-time and compared blind to conventional invasive FFR by an independent core laboratory. The primary endpoint was the agreement between caFFR and FFR, with a pre-specified performance goal of 84%. Between June and December 2018, matched caFFR and FFR measurements were performed in 328 coronary arteries. Total operational time for caFFR was 4.54 ± 1.48 min. caFFR was highly correlated to FFR (R = 0.89, P = 0.76) with a mean bias of −0.002 ± 0.049 (95% limits of agreement −0.098 to 0.093). The diagnostic performance of caFFR vs. FFR was diagnostic accuracy 95.7%, sensitivity 90.4%, specificity 98.6%, positive predictive value 97.2%, negative predictive value 95.0%, and area under the receiver operating characteristic curve of 0.979. Conclusions Using wire-based FFR as the reference, caFFR has high accuracy, sensitivity, and specificity. caFFR could eliminate the need of a pressure wire, technical error and potentially increase adoption of physiological assessment of coronary artery stenosis severity. Clinical Trial Registration URL: http://www.chictr.org.cn Unique Identifier: ChiCTR1800019522.

Fractional flow reserve derived from conventional coronary angiograms and computational fluid dynamics

2015 ◽  
Vol 190 ◽  
pp. 187-189 ◽  
Author(s):  
Anastasios Kopanidis ◽  
Ioannis Pantos ◽  
Andreas Theodorakakos ◽  
Efthalia Tzanalaidou ◽  
Demosthenes Katritsis
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Coronary Angiograms
Sign in / Sign up

Export Citation Format

Share Document