Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: Comparison with pressure wire - fractional flow reserve

Michail I. Papafaklis, Takashi Muramatsu, Yuki Ishibashi, Lampros S. Lakkas, Shimpei Nakatani, Christos V. Bourantas, Jurgen Ligthart, Yoshinobu Onuma, Mauro Echavarria-Pinto, Georgia Tsirka, Anna Kotsia, Dimitrios N. Nikas, Owen Mogabgab, Robert Jan Van Geuns, Katerina K. Naka, Dimitrios I. Fotiadis, Emmanouil S. Brilakis, Héctor M. Garcia-Garcia, Javier Escaned, Felix ZijlstraLampros K. Michalis, Patrick W. Serruys

Research output: Contribution to journalArticlepeer-review

85 Citations (Scopus)

Abstract

Aims: To develop a simplified approach of virtual functional assessment of coronary stenosis from routine angiographic data and test it against fractional flow reserve using a pressure wire (wire-FFR).

Methods and results: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by wire-FFR (reference standard: .0.80). The 3D-QCA models were processed with computational fluid dynamics (CFD) to calculate the lesion-specific pressure gradient (?¢P) and construct the ?¢P.flow curve, from which the virtual functional assessment index (vFAI) was derived. The discriminatory power of vFAI for ischaemia-producing lesions was high (area under the receiver operator characteristic curve [AUC]: 92% [95% CI: 86-96%]). Diagnostic accuracy, sensitivity and specificity for the optimal vFAI cut-point (.0.82) were 88%, 90% and 86%, respectively. Virtual-FAI demonstrated superior discrimination against 3D-QCA.derived % area stenosis (AUC: 78% [95% CI: 70-84%]; p<0.0001 compared to vFAI). There was a close correlation (r=0.78, p<0.0001) and agreement of vFAI compared to wire-FFR (mean difference: .0.0039?}0.085, p=0.59).

Conclusions: We developed a fast and simple CFD-powered virtual haemodynamic assessment model using only routine angiography and without requiring any invasive physiology measurements/hyperaemia induction. Virtual-FAI showed a high diagnostic performance and incremental value to QCA for predicting wire-FFR; this ?gless invasive?h approach could have important implications for patient management and cost.

Original languageEnglish
Pages (from-to)574-583
Number of pages10
JournalEuroIntervention
Volume10
Issue number5
DOIs
Publication statusPublished - 01-09-2014
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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