Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve

Michail I. Papafaklis, Takashi Muramatsu, Yuki Ishibashi, Christos V. Bourantas, Dimitrios I. Fotiadis, Emmanouil S. Brilakis, Héctor M. Garcia-Garcia, Javier Escaned, Patrick W. Serruys, Lampros K. Michalis

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: Fractional flow reserve (FFR) has been established as a useful diagnostic tool. The distal coronary pressure to aortic pressure (Pd/Pa) ratio at rest is a simpler physiologic index but also requires the use of the pressure wire, whereas recently proposed virtual functional indices derived from coronary imaging require complex blood flow modelling and/or are time-consuming. Our aim was to test the diagnostic performance of virtual resting Pd/Pa using routine angiographic images and a simple flow model. Methods: Three-dimensional quantitative coronary angiography (3D-QCA) was performed in 139 vessels (120 patients) with intermediate lesions assessed by FFR. The resting Pd/Pa for each lesion was assessed by computational fluid dynamics. Results: The discriminatory power of virtual resting Pd/Pa against FFR (reference: ≤0.80) was high (area under the receiver operator characteristic curve [AUC]: 90.5% [95% CI: 85.4–95.6%]). Diagnostic accuracy, sensitivity and specificity for the optimal virtual resting Pd/Pa cut-off (≤0.94) were 84.9%, 90.4% and 81.6%, respectively. Virtual resting Pd/Pa demonstrated superior performance (p < 0.001) versus 3D-QCA %area stenosis (AUC: 77.5% [95% CI: 69.8–85.3%]). There was a good correlation between virtual resting Pd/Pa and FFR (r = 0.69, p < 0.001). Conclusions: Virtual resting Pd/Pa using routine angiographic data and a simple flow model provides fast functional assessment of coronary lesions without requiring the pressure-wire and hyperaemia induction. The high diagnostic performance of virtual resting Pd/Pa for predicting FFR shows promise for using this simple/fast virtual index in clinical practice.

Original languageEnglish
Pages (from-to)377-380
Number of pages4
JournalHeart Lung and Circulation
Volume27
Issue number3
DOIs
Publication statusPublished - 03-2018

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve'. Together they form a unique fingerprint.

  • Cite this

    Papafaklis, M. I., Muramatsu, T., Ishibashi, Y., Bourantas, C. V., Fotiadis, D. I., Brilakis, E. S., Garcia-Garcia, H. M., Escaned, J., Serruys, P. W., & Michalis, L. K. (2018). Virtual Resting Pd/Pa From Coronary Angiography and Blood Flow Modelling: Diagnostic Performance Against Fractional Flow Reserve. Heart Lung and Circulation, 27(3), 377-380. https://doi.org/10.1016/j.hlc.2017.03.163