A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve

Chu, Miao; Yang, Jian; Westra, Jelmer; Tu, Shengxian

doi:10.1007/s10554-017-1085-3

Cited by 24 publications

(21 citation statements)

References 78 publications

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“…In an attempt to further simplify calculations a 1D model was compared with a 3D model, and found to yield nearly similar findings for FFR (16). Findings reported in 38 studies (17) are summarized in Figure 9 which further illustrates the discrepancy between FFR and diameter-based indicators of coronary luminal obstruction.…”

Section: Evaluation Of Ffr Data Presented In the Literaturementioning

confidence: 68%

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Fractional Flow Reserve Evaluated as Metric of Coronary Stenosis — A Mathematical Model Study

Faes

Meer

Heyndrickx³

et al. 2020

Front. Cardiovasc. Med.

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Introduction: Coronary arterial stenosis may impair myocardial perfusion with myocardial ischemia and associated morbidity and mortality as result. The myocardial fractional flow reserve (FFR) is clinically used as a stenosis-specific index. Aim: This study aims to identify the relation between the FFR and the degree of coronary arterial stenosis using a simple mathematical model of the coronary circulation. Methods: A mathematical model of the coronary circulation, including an arterial stenosis of variable degree, was developed. The relation between the FFR and the degree of stenosis (defined as the fractional cross sectional area narrowing) was investigated, including the influence of the aortic and venous pressures and the capillary resistance. An additional study concerning 22 patients with coronary artery disease permits comparison of clinical data and in silico findings. Results: The FFR shows an S-shaped relationship with the stenosis index. We found a marked influence of venous and aortic pressure and capillary resistance. The FFR is accompanied by a clinically relevant co-metric (FFR C), defined by the Pythagorean sum of the two pressures in the definition formula for FFR. In the patient group the FFR C is strongly related to the post-stenotic pressure (R = 0.91). The FFR C requires establishment of a validated cutoff point using future trials. Conclusion: The S-shaped dependence of FFR on the severity of the stenosis makes the FFR a measure of the ordinal scale. The marked influences of the aortic and venous pressures and the capillary resistance on the FFR will be interpreted as significant variations in intra-and inter-individual clinical findings. These fluctuations are partly connected to the neglect of considering the FFR C. At otherwise identical conditions the FFR as measured at baseline differs from the value obtained during hyperemic conditions. This expected observation requires further investigation, as the current hyperemia based evaluation fails to take advantage of available baseline data.

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Section: Evaluation Of Ffr Data Presented In the Literaturementioning

confidence: 68%

“…The yellow shaded area refers to values of 0.78 ≤ FFR ≤ 0.82 around the common cut-off point, which narrow range corresponds with (averaged) diameter reduction anywhere between 45 and 55%. Data from Chu et al (17).…”

Section: Evaluation Of Ffr Data Presented In the Literaturementioning

confidence: 99%

Fractional Flow Reserve Evaluated as Metric of Coronary Stenosis — A Mathematical Model Study

Faes

Meer

Heyndrickx³

et al. 2020

Front. Cardiovasc. Med.

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“…Angiographic mismatch with the functional significance of coronary stenosis most frequently occurs in the left anterior descending artery (LAD) with FFR ≤ 0.80 and a visual or QCA diameter stenosis <50% . This is likely due to the large amount of myocardium supplied by LAD and emphasizes the need for physiological assessment to identify LAD lesions that may benefit from revascularization.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Westra

Campo

et al. 2019

Cathet Cardio Intervent

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Objectives We aimed to provide robust performance estimates for quantitative flow ratio (QFR) in assessment of intermediary coronary lesions. Background Angiography‐based functional lesion assessment by QFR may appear as a cost saving and safe approach to expand the use of physiology‐guided percutaneous coronary interventions. QFR was proven feasible and showed good diagnostic performance in mid‐sized off‐line and on‐line studies with fractional flow reserve (FFR) as reference standard. Methods We performed a collaborative individual patient‐data meta‐analysis of all available prospective studies with paired assessment of QFR and FFR using the CE‐marked QFR application. The main outcome was agreement of QFR and FFR using a two‐step analysis strategy with a multilevel mixed model accounting for study and center level variation. Results Of 16 studies identified, four studies had prospective enrollment and provided patient level data reaching a total of 819 patients and 969 vessels with paired FFR and QFR: FAVOR Pilot (n = 73); WIFI II (n = 170); FAVOR II China (n = 304) and FAVOR II Europe‐Japan (n = 272). We found an overall agreement (mean difference 0.009 ± 0.068, I2 = 39.6) of QFR with FFR. The diagnostic performance was sensitivity 84% (95%CI: 77–90, I2 = 70.1), specificity 88% (95%CI: 84–91, I2 = 60.1); positive predictive value 80% (95%CI: 76–85, I2 = 33.4), and negative predictive value 95% (95%CI: 93–96, I2 = 75.9). Conclusions Diagnostic performance of QFR was good with FFR as reference in this meta‐analysis of high quality studies. QFR could provide an easy, safe, and cost‐effective solution for functional evaluation of coronary artery stenosis.

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“…In July 2017 the Topical issue on Emerging concepts on Invasive and Noninvasive Coronary Physiological Assessment was published with a great overview over the various imaging modalities with a total of 15 scientific papers by the experts in this field on invasive and non-invasive flow reserve, flow-pressure relationships, microvascular dysfunction, perfusion imaging and wall shear stress [94][95][96][97][98][99][100][101][102][103][104][105][106][107][108].…”

Section: Topical Issue On Emerging Concepts On Invasive and Noninvasimentioning

confidence: 99%

Cardiovascular imaging 2017 in the International Journal of Cardiovascular Imaging

Reiber

Alaiti

Bezerra

et al. 2018

Int J Cardiovasc Imaging

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A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve

Cited by 24 publications

References 78 publications

Fractional Flow Reserve Evaluated as Metric of Coronary Stenosis — A Mathematical Model Study

Fractional Flow Reserve Evaluated as Metric of Coronary Stenosis — A Mathematical Model Study

Diagnostic performance of quantitative flow ratio in prospectively enrolled patients: An individual patient‐data meta‐analysis

Cardiovascular imaging 2017 in the International Journal of Cardiovascular Imaging

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