Influence of the position of the distal pressure measurement point on the Fractional Flow Reserve using in-silico simulations

2021 ◽  
Author(s):  
Rafael Agujetas ◽  
Conrado Ferrera ◽  
Reyes González-Fernández ◽  
Juan Nogales-Asensio ◽  
Ana Fernández-Tena
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Computational Simulation ◽  
Severe Heart Failure ◽  
Invasive Procedure ◽  
Clinical Decision ◽  
Aortic Pressure ◽  
Computed Tomographic Angiography ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Coronary stenosis is largely responsible of severe heart failure as they can stop the blood flow to the myocardial. The Fractional Flow Reserve, the ratio of the mean distal coronary pressure to mean aortic pressure, is the most usual functional assessment of the severity of the coronary stenosis. In most cases, its value dictates the clinical decision to set a stent to restore the flow. Therefore, a correct measurement of this variable is crucial. The objective of this work is to evaluate how the Fractional Flow Reserve value is altered depending on the point where the distal pressure is measured. This information can be very important to prevent cardiologists from making the wrong clinical decisions. From the data taken from anonymous patients who underwent Coronary Computed Tomographic Angiography and cardiac catheterization, a comparison was made with the results of a computational simulation of the model reconstructed from the angiography. The results of the Fractional Flow Reserve obtained by simulation (0.834) agree with those obtained experimentally (0.830), difference less than 0.8%, which indicates that with simulation more results can be obtained than experimentally would be impossible to achieve. The actual invasive procedure to measure the Fractional Flow Reserve is being executed with a protocol that do not consider the influence of the location on the distal pressure value. The new procedure would avoid false results related to the point where the distal pressure is measured.

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.

Combining Baseline Distal-to-Aortic Pressure Ratio and Fractional Flow Reserve in the Assessment of Coronary Stenosis Severity

2015 ◽  
Vol 8 (13) ◽  
pp. 1681-1691 ◽  
Author(s):  
Mauro Echavarría-Pinto ◽  
Tim P. van de Hoef ◽  
Martijn A. van Lavieren ◽  
Sukhjinder Nijjer ◽  
Borja Ibañez ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Stenosis Severity

scholarly journals TCT-300 Combining baseline distal-to-aortic pressure ratio and fractional flow reserve in the assessment of coronary stenosis severity

2015 ◽  
Vol 66 (15) ◽  
pp. B119
Author(s):  
Mauro Echavarria-Pinto ◽  
Tim P. van de Hoef ◽  
Martijn A. van Lavieren ◽  
Sukhjinder S. Nijjer ◽  
Borja Ibañez ◽  
...  
Keyword(s):  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Pressure Ratio ◽  
Aortic Pressure ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Stenosis Severity

Additional value of deep learning computed tomographic angiography-based fractional flow reserve in detecting coronary stenosis and predicting outcomes

2021 ◽  
pp. 028418512098397
Author(s):  
Yang Li ◽  
Hong Qiu ◽  
Zhihui Hou ◽  
Jianfeng Zheng ◽  
Jianan Li ◽  
...  
Keyword(s):  
Deep Learning ◽  
Unstable Angina ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Computed Tomographic Angiography ◽  
Fractional Flow ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
Sensitivity Specificity ◽  
Tomographic Angiography

Background Deep learning (DL) has achieved great success in medical imaging and could be utilized for the non-invasive calculation of fractional flow reserve (FFR) from coronary computed tomographic angiography (CCTA) (CT-FFR). Purpose To examine the ability of a DL-based CT-FFR in detecting hemodynamic changes of stenosis. Material and Methods This study included 73 patients (85 vessels) who were suspected of coronary artery disease (CAD) and received CCTA followed by invasive FFR measurements within 90 days. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristics curve (AUC) were compared between CT-FFR and CCTA. Thirty-nine patients who received drug therapy instead of revascularization were followed for up to 31 months. Major adverse cardiac events (MACE), unstable angina, and rehospitalization were evaluated and compared between the study groups. Results At the patient level, CT-FFR achieved 90.4%, 93.6%, 88.1%, 85.3%, and 94.9% in accuracy, sensitivity, specificity, PPV, and NPV, respectively. At the vessel level, CT-FFR achieved 91.8%, 93.9%, 90.4%, 86.1%, and 95.9%, respectively. CT-FFR exceeded CCTA in these measurements at both levels. The vessel-level AUC for CT-FFR also outperformed that for CCTA (0.957 vs. 0.599, P < 0.0001). Patients with CT-FFR ≤0.8 had higher rates of rehospitalization (hazard ratio [HR] 4.51, 95% confidence interval [CI] 1.08–18.9) and MACE (HR 7.26, 95% CI 0.88–59.8), as well as a lower rate of unstable angina (HR 0.46, 95% CI 0.07–2.91). Conclusion CT-FFR is superior to conventional CCTA in differentiating functional myocardial ischemia. In addition, it has the potential to differentiate prognoses of patients with CAD.

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