scholarly journals Predictors of CT-derived FFR in patients with suspected CAD beyond severity of coronary stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Smolka ◽  
A Fava ◽  
M Moshage ◽  
M Marwan ◽  
S Achenbach ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Regression Analysis ◽  
Image Quality ◽  
Coronary Stenosis ◽  
Cleveland Clinic ◽  
Suspected Coronary Artery Disease ◽  
Fractional Flow ◽  
Clinical Criteria ◽  
Flow Reserve

Abstract Background Functional assessment of coronary stenosis using computational fluid dynamics is increasingly used, however other factors besides coronary stenosis may affect the results. We assessed several predictors for CT-derived fractional flow reserve (CT-FFR) in patients with suspected coronary artery disease (CAD) undergoing coronary computed tomographic angiography (CCTA). Methods 2505 consecutive patients with suspected CAD undergoing CCTA from 2008 to 2016 were screened, 1549 were excluded due to incomplete data (934), image quality (345), software error (147) or other reasons (123). Minimal CT-FFR was measured using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany) in coronaries ≥2mm. Several clinical as well as technical criteria were assessed for predicting the minimal CT-FFR per patient. Results 956 patients (51±12 years, 51.2% men) were included in this analysis. Mean EF was 59.4±7.4%, heart rate 63±9 bpm, systolic (126.5±20mmHg) and diastolic (70±11 mmHg) blood pressure (BP). Regression analysis and ANOVA showed low but significant impact on minimal CT-FFR (mean 0.85±0.10) by EF, aortic valvular dysfunction, heart rate and systolic blood pressure as well as image quality (esp. blooming and image noise). See Tables 1 and 2. Conclusion Coronary stenosis may not be the only relevant predictor for CT-FFR. Several clinical criteria (EF, heart rate, BP, aortic valve dysfunction) as well as image criteria (image quality, artifacts) can affect CT-FFR results. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Cleveland Clinic Foundation Table 1. ANOVA analysis Table 2. Regression analysis

P6319CT derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R P J Budde ◽  
F M A Nous ◽  
A A Constantinescu ◽  
K Nieman ◽  
L M Koweek ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Vessel Disease ◽  
Transplant Patients ◽  
Flow Reserve

Abstract Background Cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality after heart transplantation. Annual screening is recommended to improve risk stratification and early treatment of CAV and is often performed with invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) with CCTA-derived fractional flow reserve (FFRct) might be a non-invasive alternative to ICA for the surveillance of CAV providing both anatomical and functional information. Purpose To describe our initial results with CCTA and FFRct for detection of CAV in a cohort of heart transplant patients. Methods Heart transplant patients who underwent CCTA with FFRct as part of routine annual assessment for CAV were enrolled in a prospective registry from February 2018 to February 2019 in a single center. The most recently known CAV score (0–3) based on invasive angio and single photon emission computed tomography (SPECT) before CCTA was recorded. CCTA image quality was scored as non-diagnostic, moderate, good or excellent. FFRct analysis was performed off-site by a commercial company. For each coronary stenosis >30%, an FFRCTvalue distal to the stenosis was measured. For the RCA, LAD and CX without a stenosis, the FFRct value in the most distal location in the vessel was recorded. CAV classification was rescored based on CCTA. Demographics, additional diagnostic tests, and treatment plans were evaluated including major adverse events (MACE) during 90-day follow-up. Results 65 patients (56 (39–65) years (median/ 25th–75thpercentile), 40% women) that were 11 (7–16) years after transplantation were included. The most recent CAV score was 0 in 52 patients (80%) and 1 or 2 in 13 patients. CCTA image quality was good or excellent in 59 (91%) patients. CCTA reclassified CAV scores in 32 (49%) patients to 33 patients with CAV 0, 18 patients with CAV 1, 9 patients with CAV 2 and 5 patients with CAV 3. In 17 patients (26%) at least one stenosis with FFRct ≤0.80 was detected including 11 patients with single vessel disease, 5 with two-vessel disease and one with three-vessel disease. In the 48 patients without a focal stenosis, mean distal FFRct values were 0.88 (0.86–0.91), 0.87 (0.85–0.90) and 0.90 (0.86–0.91) at less than 10, 10–15 or more than 15 years after transplantation, respectively (p=0.457). Additional tests were performed in 10 (15%) patients (1 SPECT and 10 invasive coronary angiographies), which resulted in revascularization by PCI in 6 (9%) patients. No MACE occurred during 90-day follow-up. Conclusion CCTA with FFRct can be successfully performed in heart transplant patients, detects patients with significant coronary stenosis and CCTA leads to substantial reclassification of CAV grades. Acknowledgement/Funding FFRct analysis was performed as part of the ADVANCE registry which is supported by Heartflow Inc.

Influence of heart rate on fractional flow reserve, pressure drop coefficient, and lesion flow coefficient for epicardial coronary stenosis in a porcine model

2011 ◽  
Vol 300 (1) ◽  
pp. H382-H387 ◽  
Author(s):  
Kranthi K. Kolli ◽  
R. K. Banerjee ◽  
Srikara V. Peelukhana ◽  
T. A. Helmy ◽  
M. A. Leesar ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pressure Drop ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Flow Coefficient ◽  
Fractional Flow ◽  
Mean Values ◽  
Flow Reserve ◽  
The Mean ◽  
Lesion Flow Coefficient

A limitation in the use of invasive coronary diagnostic indexes is that fluctuations in hemodynamic factors such as heart rate (HR), blood pressure, and contractility may alter resting or hyperemic flow measurements and may introduce uncertainties in the interpretation of these indexes. In this study, we focused on the effect of fluctuations in HR and area stenosis (AS) on diagnostic indexes. We hypothesized that the pressure drop coefficient (CDPe, ratio of transstenotic pressure drop and distal dynamic pressure), lesion flow coefficient (LFC, square root of ratio of limiting value CDP and CDP at site of stenosis) derived from fluid dynamics principles, and fractional flow reserve (FFR, ratio of average distal and proximal pressures) are independent of HR and can significantly differentiate between the severity of stenosis. Cardiac catheterization was performed on 11 Yorkshire pigs. Simultaneous measurements of distal coronary arterial pressure and flow were performed using a dual sensor-tipped guidewire for HR < 120 and HR > 120 beats/min, in the presence of epicardial coronary lesions of <50% AS and >50% AS. The mean values of FFR, CDPe, and LFC were significantly different ( P < 0.05) for lesions of <50% AS and >50% AS (0.88 ± 0.04, 0.76 ± 0.04; 62 ± 30, 151 ± 35, and 0.10 ± 0.02 and 0.16 ± 0.01, respectively). The mean values of FFR and CDPe were not significantly different ( P > 0.05) for variable HR conditions of HR < 120 and HR > 120 beats/min (FFR, 0.81 ± 0.04 and 0.82 ± 0.04; and CDPe, 95 ± 33 and 118 ± 36). The mean values of LFC do somewhat vary with HR (0.14 ± 0.01 and 0.12 ± 0.02). In conclusion, fluctuations in HR have no significant influence on the measured values of CDPe and FFR but have a marginal influence on the measured values of LFC. However, all three parameters can significantly differentiate between stenosis severities. These results suggest that the diagnostic parameters can be potentially used in a better assessment of coronary stenosis severity under a clinical setting.

scholarly journals A Computational Analysis of the Influence of a Pressure Wire in Evaluating Coronary Stenosis

Fluids ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 165
Author(s):  
Jie Yi ◽  
Fang-Bao Tian ◽  
Anne Simmons ◽  
Tracie Barber
Keyword(s):  
Coronary Stenosis ◽  
Severe Case ◽  
Patient Specific ◽  
Fractional Flow ◽  
Ideal Model ◽  
Coronary Pressure ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Physical Presence ◽  
The Difference

Cardiovascular disease is one of the world’s leading causes of morbidity and mortality. Fractional flow reserve (FFR) was proposed in the 1990s to more accurately evaluate the functional severity of intermediate coronary stenosis, and it is currently the gold standard in cardiac catheterization laboratories where coronary pressure and flow are routinely obtained. The clinical measurement of FFR relies on a pressure wire for the recording of pressures; however, in computational fluid dynamics studies, an FFR is frequently predicted using a wire-absent model. We aim to investigate the influence of the physical presence of a 0.014-inch (≈0.36 mm) pressure wire in the calculation of virtual FFR. Ideal and patient-specific models were simulated with the absence and presence of a pressure wire. The computed FFR reduced from 0.96 to 0.93 after inserting a wire in a 3-mm non-stenosed (pipe) ideal model. In mild stenotic cases, the difference in FFR between the wire-absent and wire-included models was slight. The overestimation in severe case was large but is of less clinical significance because, in practice, this tight lesion does not require sophisticated measurement to be considered critical. However, an absence of the pressure wire in simulations could contribute to an over-evaluation for an intermediate coronary stenosis.

Abstract 14743: Usefulness of Estimated Coronary Flow Velocity Using Quantitative Flow Ratio for Intermediate Coronary Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Eiji Ichimoto ◽  
Nao Konagai ◽  
Sawako Horie ◽  
Atsushi Hasegawa ◽  
Hirofumi Miyahara ◽  
...  
Keyword(s):  
Flow Velocity ◽  
Coronary Stenosis ◽  
Coronary Flow ◽  
Flow Ratio ◽  
Operating Characteristics ◽  
Fractional Flow ◽  
Coronary Flow Velocity ◽  
Flow Reserve ◽  
Quantitative Flow Ratio ◽  
Quantitative Flow

Introduction: Quantitative flow ratio (QFR) is a diagnostic modality for functional assessment for intermediate coronary stenosis without the use of pressure wire. QFR is calculated from 3-dimensional quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis. Hypothesis: We assessed the usefulness of QFR and the association with an estimated coronary flow velocity (eCFV) for intermediate coronary stenosis. Methods: A total of 100 lesions in 80 consecutive patients were assessed Fractional Flow Reserve (FFR) for intermediate coronary stenosis between January 2011 and April 2019. Of these, 97 lesions in 77 patients who underwent QFR were included in this study. Patients were classified into two groups (FFR ≤ 0.80 or FFR > 0.80). QFR and eCFV using contrast were measured by Thrombolysis in Myocardial Infarction (TIMI) frame counts. Results: There was no significant differences in target vessels (p = 0.90) and diffuse lesions (p = 0.06) between the two groups (FFR ≤ 0.80 or FFR > 0.80). Mean FFR and QFR values were 0.78 ± 0.12 and 0.77 ± 0.11, respectively. QFR had a good correlation with FFR values (r = 0.86, p < 0.0001). The diagnostic accuracy, sensitivity, and specificity on QFR ≤ 0.80 were 91.8%, 92.7% and 90.5%, respectively. The eCFV of FFR ≤ 0.80 was greater than that of FFR > 0.80 (0.19 ± 0.08 m/s vs. 0.14 ± 0.06 m/s, p<0.001). Figure showed that the eCFV correlated with FFR values (r = -0.29, p < 0.01). Moreover, the eCFV had a high area under the curve (AUC = 0.71, p < 0.01) on Receiver operating characteristics curve (ROC) analysis with FFR ≤ 0.80. Conclusions: QFR was useful for the assessment of functional stenosis severity. As eCFV was faster, FFR was lower for intermediate coronary stenosis. The eCFV had a good correlation with FFR and may become one of the evaluations for ischemia.

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