CT-based fractional flow reserve: development and expanded application

Computations of fractional flow reserve, based on CT coronary angiography and computational fluid dynamics (CT-based FFR) to assess the severity of coronary artery stenosis, was introduced around a decade ago and is now one of the most successful applications of computational fluid dynamic modelling in clinical practice. Although the mathematical modelling framework behind this approach and the clinical operational model vary, its clinical efficacy has been demonstrated well in general. In this review, technical elements behind CT-based FFR computation are summarised with some key assumptions and challenges. Examples of these challenges include the complexity of the model (such as blood viscosity and vessel wall compliance modelling), whose impact has been debated in the research. Efforts made to address the practical challenge of processing time are also reviewed. Then, further application areas – myocardial bridge, renal stenosis and lower limb stenosis – are discussed along with specific challenges expected in these areas.

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Computed Tomographic Angiography–Based Fractional Flow Reserve Compared With Catheter-Based Dobutamine-Stress Diastolic Fractional Flow Reserve in Symptomatic Patients With a Myocardial Bridge and No Obstructive Coronary Artery Disease

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.119.009576 ◽

2020 ◽

Vol 13 (2) ◽

Author(s):

Ayman Jubran ◽

Ingela Schnittger ◽

Jennifer Tremmel ◽

Vedant Pargaonkar ◽

Ian Rogers ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Obstructive Coronary Artery Disease ◽

Dobutamine Stress ◽

Computed Tomographic Angiography ◽

Fractional Flow ◽

Myocardial Bridge ◽

Computed Tomographic ◽

Flow Reserve ◽

Artery Disease ◽

Tomographic Angiography

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TCT-346 Association between Increased Number of Septal Branches within the Myocardial Bridge and Abnormal Diastolic-Fractional Flow Reserve

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2015.08.964 ◽

2015 ◽

Vol 66 (15) ◽

pp. B139-B140

Author(s):

Takumi Kimura ◽

Shigemitsu Tanaka ◽

Kozo Okada ◽

Hideki Kitahara ◽

Yuhei Kobayashi ◽

...

Keyword(s):

Fractional Flow Reserve ◽

Fractional Flow ◽

Myocardial Bridge ◽

Flow Reserve

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Extensive unroofing of myocardial bridge: A case report and literature review

SAGE Open Medical Case Reports ◽

10.1177/2050313x18823380 ◽

2019 ◽

Vol 7 ◽

pp. 2050313X1882338 ◽

Cited By ~ 4

Author(s):

Salvior Mok ◽

David Majdalany ◽

Gosta B Pettersson

Keyword(s):

Fractional Flow Reserve ◽

Aortic Surgery ◽

Coronary Spasm ◽

Management Decision ◽

Fractional Flow ◽

Myocardial Bridge ◽

Coronary Insufficiency ◽

Left Anterior Descending Artery ◽

Flow Reserve ◽

Multiple Imaging

Background: Myocardial bridge is defined as a segment of a coronary artery that takes an intramyocardial course. The presence of myocardial bridge has been observed in as many as 40%–80% of cases on autopsy, angiographically from 0.5% to 16.0%, and often asymptomatic. However, it has been associated with angina, coronary spasm, myocardial infarction, arrhythmias, syncope, sudden cardiac arrest, and death. Conflicting opinions exist on the timing of surgical intervention for myocardial bridge. Methods: We present an unusual case of a young female, with prior aortic surgery, who had refractory chest pain despite optimal medical therapy. Stress testing revealed anterior ischemia. Cardiac catherization showed myocardial bridge of the left anterior descending artery with significant compromise of blood flow (fractional flow reserve = 0.75 with adenosine). We proceeded with surgery. Intraoperatively, we found an unusually long (10-cm) intramyocardial segment of the left anterior descending artery which was managed by surgically unroofing. Our patient felt better post procedure. Repeat cardiac catheterization showed no further narrowing of the left anterior descending artery with a fractional flow reserve of 0.87 in its distal segment. Results/discussion: Myocardial bridge is present mostly in female patients (74.5%), with median age at 56.2 years and mostly involving the left anterior descending artery (77.2%). The average length of myocardial bridge is 21.85 ± 16.10 mm (range: 5–70 mm). Our case is unique as the involved myocardial bridge was 10 cm in length, the longest ever reported. Multiple imaging modality revealed significant coronary insufficiency, with a subsequent clinical and angiographic improvement upon unroofing of the culprit coronary vessel. Conclusion: Management decision on myocardial bridge remains controversial. This is a case of the longest symptomatic myocardial bridge, with a subsequent improvement post unroofing.

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