Fractional Flow Reserve Estimation in Coronary Arteries by Forward Geometrical Modeling

2013 ◽  
Author(s):  
Jelle T. C. Schrauwen ◽  
Jolanda J. Wentzel ◽  
Anton F. W. van der Steen ◽  
Frank J. H. Gijsen
Keyword(s):  
Clinical Practice ◽  
Pressure Drop ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Reserve Estimation ◽  
Important Indicator ◽  
Flow Reserve ◽  
Pressure Wire

Fractional Flow Reserve (FFR) is an important indicator for the hemodynamic significance of a coronary stenosis [1]. The FFR is defined as the pressure drop over the stenosis under hyperemia. The pressure drop, and thus the FFR, depends on both the geometry and flow. In clinical practice, the FFR is measured with a pressure wire under administration of adenosine and intervention is warranted if the FFR is below 0.8.

scholarly journals Comparison of Machine Learning Computed Tomography-Based Fractional Flow Reserve and Coronary CT Angiography-Derived Plaque Characteristics with Invasive Resting Full-Cycle Ratio

2020 ◽  
Vol 9 (3) ◽  
pp. 714
Author(s):  
Stefan Baumann ◽  
Markus Hirt ◽  
Christina Rott ◽  
Gökce H. Özdemir ◽  
Christian Tesche ◽  
...  
Keyword(s):  
Machine Learning ◽  
Computed Tomography ◽  
Coronary Artery ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Luminal Diameter ◽  
Coronary Computed Tomography ◽  
Flow Reserve ◽  
Pressure Wire

Background: The aim is to compare the machine learning-based coronary-computed tomography fractional flow reserve (CT-FFRML) and coronary-computed tomographic morphological plaque characteristics with the resting full-cycle ratio (RFRTM) as a novel invasive resting pressure-wire index for detecting hemodynamically significant coronary artery stenosis. Methods: In our single center study, patients with coronary artery disease (CAD) who had a clinically indicated coronary computed tomography angiography (cCTA) and subsequent invasive coronary angiography (ICA) with pressure wire-measurement were included. On-site prototype CT-FFRML software and on-site CT-plaque software were used to calculate the hemodynamic relevance of coronary stenosis. Results: We enrolled 33 patients (70% male, mean age 68 ± 12 years). On a per-lesion basis, the area under the receiver operating characteristic curve (AUC) of CT-FFRML (0.90) was higher than the AUCs of the morphological plaque characteristics length/minimal luminal diameter4 (LL/MLD4; 0.80), minimal luminal diameter (MLD; 0.77), remodeling index (RI; 0.76), degree of luminal diameter stenosis (0.75), and minimal luminal area (MLA; 0.75). Conclusion: CT-FFRML and morphological plaque characteristics show a significant correlation to detected hemodynamically significant coronary stenosis. Whole CT-FFRML had the best discriminatory power, using RFRTM as the reference standard.

scholarly journals Computed Tomography Myocardial Perfusion Imaging With Transesophageal Atrial Pacing Stress Test in Patients With Borderline Stenoses in the Coronary Arteries: a Comparison With Fractional Flow Reserve

Kardiologiia ◽  
2021 ◽  
Vol 61 (1) ◽  
pp. 4-11
Author(s):  
Yu. A. Omarov ◽  
T. N. Veselova ◽  
R. M. Shakhnovich ◽  
T. S. Sukhinina ◽  
N. S. Zhukova ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Myocardial Perfusion ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Coronary Stenosis ◽  
Stress Test ◽  
Atrial Pacing ◽  
Fractional Flow ◽  
Flow Reserve

Aim      To evaluate the diagnostic accuracy of cardiac perfusion computed tomography (PCT) with transesophageal electrocardiostimulation (TE ECS) for detection of ischemia in patients with borderline coronary stenosis (50–75 %) compared to measurements of fractional flow reserve (FFR).Material and methods  The study included 25 patients with borderline (50–75 %) coronary stenosis as per data of computed tomography angiography (CTA) or coronary angiography (CAG). Later the patients underwent invasive measurement of FFR and cardiac PCT on a 320-row detector tomograph in combination with the TE ECS stress test.  FFR values <0.8 indicated the hemodynamic significance of stenosis. Myocardial perfusion was evaluated visually based on consensus of two experts.Results All patients completed the study protocol. Cardiac pacing duration was 6 min for all patients. Four patients required intravenous administration of atropine sulphate. PCT with TE ECS detected significant for FFR stenoses with sensitivity, specificity, and predictive value of a positive result and predictive value for a negative result of 47, 90, 87, and 53 %, respectively.Conclusion      PCT with TE ECS in combination with CTA can be considered as an informative method for simultaneous evaluation of the condition of coronary arteries and detection of myocardial ischemia. This method is particularly relevant for assessing the hemodynamic significance of borderline coronary stenoses.

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.

Numerical simulation of fractional flow reserve in atherosclerotic coronary arteries

2021 ◽  
Author(s):  
Igor Saveljic ◽  
Tijana Djukic ◽  
Dalibor Nikolic ◽  
Smiljana Djorovic ◽  
Nenad Filipovic
Keyword(s):  
Numerical Simulation ◽  
Coronary Arteries ◽  
Fractional Flow Reserve ◽  
Fractional Flow ◽  
Flow Reserve

Fractional flow reserve

2021 ◽  
pp. 63-67
Author(s):  
Giovanni Ciccarelli ◽  
Emanuele Barbato ◽  
Bernard De Bruyne
Keyword(s):  
Blood Flow ◽  
Myocardial Blood Flow ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Coronary Intervention ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Coronary Pressure ◽  
Flow Reserve ◽  
Percutaneous Coronary

Fractional flow reserve is an index of the physiological significance of a coronary stenosis, defined as the ratio of maximal myocardial blood flow in the presence of the stenosis to the theoretically normal maximal myocardial blood flow (i.e. in the absence of the stenosis). This flow ratio can be calculated from the ratio of distal coronary pressure to central aortic pressure during maximal hyperaemia. More practically, fractional flow reserve indicates to what extent the epicardial segment can be responsible for myocardial ischaemia and, accordingly, fractional flow reserve quantifies the expected perfusion benefit from revascularization by percutaneous coronary intervention. Very limited evidence exists on the role on fractional flow reserve for bypass grafts.

Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation

2019 ◽  
Vol 41 (34) ◽  
pp. 3271-3279 ◽  
Author(s):  
Shengxian Tu ◽  
Jelmer Westra ◽  
Julien Adjedj ◽  
Daixin Ding ◽  
Fuyou Liang ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Diagnostic Methods ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Catheterization Laboratory ◽  
Flow Reserve ◽  
Pressure Wire ◽  
Stenosis Severity ◽  
Procedural Guidance ◽  
Invasive Measurement

Abstract Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory. Computational FFR has the potential to expand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.

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