Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions

Zhang, Junmei; Dongsi, Shuang; Baskaran, Lohendran; Wu, Weijun; Teo, Soo-Kng; Huang, Weimin; Gobeawan, Like; Allen, John C.; Tan, Ru San; Su, Xi; Ismail, Nasrul Bin; Wan, Min; Su, Boyang; Zou, Hua; Low, Ris; Zhao, Xiaodan; Chi, Yuan; Zhou, Jinyun; Su, Yi; Lomarda, Aileen Mae; Chin, Chee Yang; Fam, Jiang Ming; Keng, Felix; Wong, Aaron; Tan, Jack Wei Chieh; Yeo, Khung Keong; Wong, Philip; Chin, Chee Tang; Ho, Kay Woon; Yap, Jonathan; Kassab, Ghassan S.; Chua, Terrance; Koh, Tian Hai; Tan, Swee Yaw; Lim, Soo Teik; Zhong, Liang

doi:10.1016/j.ijcard.2018.04.020

Cited by 14 publications

(12 citation statements)

References 38 publications

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“…However, no validation was performed combining hyperemia, stenotic lesions and patient specific coronary territories, which are key ingredients in the computational estimation of FFR. Yet the use of 1D models to estimate FFR using CCTA or AX images has been recently proposed 23 – 26 , and also other works have employed simplified mathematical representations seeking to predict risk of ischemia noninvasively 27 – 29 . It is worth noting that, in the context of coronary circulation, the validation of 1D models against 3D models has only been reported in 30 , where a virtual patient population derived from a single CT scan was used.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 1D and 3D Models for the Estimation of Fractional Flow Reserve

Blanco

Bulant

Muller

et al. 2018

Sci Rep

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In this work we propose to validate the predictive capabilities of one-dimensional (1D) blood flow models with full three-dimensional (3D) models in the context of patient-specific coronary hemodynamics in hyperemic conditions. Such conditions mimic the state of coronary circulation during the acquisition of the Fractional Flow Reserve (FFR) index. Demonstrating that 1D models accurately reproduce FFR estimates obtained with 3D models has implications in the approach to computationally estimate FFR. To this end, a sample of 20 patients was employed from which 29 3D geometries of arterial trees were constructed, 9 obtained from coronary computed tomography angiography (CCTA) and 20 from intra-vascular ultrasound (IVUS). For each 3D arterial model, a 1D counterpart was generated. The same outflow and inlet pressure boundary conditions were applied to both (3D and 1D) models. In the 1D setting, pressure losses at stenoses and bifurcations were accounted for through specific lumped models. Comparisons between 1D models (FFR1D) and 3D models (FFR3D) were performed in terms of predicted FFR value. Compared to FFR3D, FFR1D resulted with a difference of 0.00 ± 0.03 and overall predictive capability AUC, Acc, Spe, Sen, PPV and NPV of 0.97, 0.98, 0.90, 0.99, 0.82, and 0.99, with an FFR threshold of 0.8. We conclude that inexpensive FFR1D simulations can be reliably used as a surrogate of demanding FFR3D computations.

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Section: Introductionmentioning

confidence: 99%

Comparison of 1D and 3D Models for the Estimation of Fractional Flow Reserve

Blanco

Bulant

Muller

et al. 2018

Sci Rep

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“…Various recent studies reported the role of CT-derived features for characterization of the functional significance of a coronary plaque. [23,24] A recent study published by Kang et al [15] demonstrated that coronary lesion geometry has a direct impact on the functional significance of a coronary stenosis, showing that complex coronary lesions are independently associated with reduced fractional flow reserve (FFR) values and that lesion eccentricity is the most significant independent predictor for low FFR. In the GEOMETRY study presented here, we extended this hypothesis to investigate for the first time the impact of lesion geometry on plaque vulnerability and the association between geometric distribution of atheromatous plaques and the related risk of future cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Impact of coronary plaque geometry on plaque vulnerability and its association with the risk of future cardiovascular events in patients with chest pain undergoing coronary computed tomographic angiography—the GEOMETRY study

et al. 2018

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Introduction:Coronary computed tomography angiography (CCTA) has emerged as a valuable noninvasive imaging tool for assessing atheromatous plaque morphology and composition, and several CCTA features have been validated as reliable indicators of the plaque-associated risk. However, the role of lesion geometry as a CCTA feature of plaque vulnerability has not been investigated so far.Material and methods:Here we present the study protocol of the GEOMETRY trial, a prospective, single center, cohort study in which we aim to investigate the relationship between plaque geometry (as expressed by cross-sectional and longitudinal plaque eccentricity) and the risk for major adverse cardiac events (MACE) during 2 years of follow-up, in order to validate plaque eccentricity as a new CCTA marker of coronary plaque vulnerability. One thousand patients with suspected coronary artery disease (CAD) and pretest probability of CAD between 15% and 85%, who undergo CCTA and in whom CCTA identifies the presence of at least 1 significant coronary plaque (producing a luminal narrowing of at least 50%) will be enrolled in the study. Based on the results of complex image post-processing and plaque analysis, patients will be divided into 2 groups: group 1—patients in whom CCTA analysis identifies only non-eccentric coronary plaque; and group 2—patients in whom CCTA analysis reveals the presence of at least 1 eccentric significant coronary plaque producing a significant luminal narrowing. Study outcomes will consist in the rate of major cardiovascular events and the rate of plaque progression during follow-up.The study is funded by the Romanian Ministry of European Funds, the Romanian Government and the European Union, as part of the research grant number 103544/2016 – PlaqueIMAGE (contract number 26/01.09.2016).Conclusion:In conclusion, GEOMETRY will be the first CCTA-based study that will investigate the impact of geometric distribution of coronary atheromatous plaque on the future risk of cardiovascular events and on the rate of plaque progression, introducing and validating a new potential feature of plaque vulnerability represented by plaque geometry.

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“…Computational fluid dynamics (CFD) methods have been combined with medical images to derive non-invasive FFR (Min et al, 2012;Nørgaard et al, 2014;Zhang et al, 2016;Zhang et al, 2018;Zhong et al, 2018) and develop virtual stenting approaches to assist PCI treatment planning (Kim et al, 2014;Gosling et al, 2019). Although these CFD based approaches have shown a high level of accuracy when compared to invasive FFR measurements (Koo et al, 2011;Min et al, 2012;Taylor et al, 2013;Nørgaard et al, 2014), the demand on computational time is significant [1-4 h (Nørgaard et al, 2014) or 6 h (Koo et al, 2011) per simulation] due to the transient simulations.…”

Section: Introductionmentioning

confidence: 99%

“…Here "B" represents "Bernoulli", as it signifies the importance of fluid mechanics in the non-invasive FFR calculation. It requires less computational time and has demonstrated excellent accuracy compared with invasive FFR measurements (Zhang et al, 2016;Zhang et al, 2018;Zhang et al, 2020). The goal of this study is to assess the performance of FFR B in predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention

Chandola

Zhang

Tan

et al. 2021

Front. Bioeng. Biotechnol.

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Invasive fractional flow reserve (FFR) is recommended to guide stent deployment. We previously introduced a non-invasive FFR calculation (FFRB) based on computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamics (CFD) and resistance boundary conditions. Current study aimed to assess the feasibility and accuracy of FFRB for predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference. Twenty-five patients who had undergone CTCA were prospectively enrolled before invasive coronary angiography (ICA) and FFR-guided percutaneous coronary intervention (PCI) on 30 coronary vessels. Using reduced-order CFD with novel boundary conditions on three-dimensional (3D) patient-specific anatomic models reconstructed from CTCA, we calculated FFRB before and after virtual stenting. The latter simulated PCI by clipping stenotic segments from the 3D coronary models and replacing them with segments to mimic the deployed coronary stents. Pre- and post-virtual stenting FFRB were compared with FFR measured pre- and post-PCI by investigators blinded to FFRB results. Among 30 coronary lesions, pre-stenting FFRB (mean 0.69 ± 0.12) and FFR (mean 0.67 ± 0.13) exhibited good correlation (r = 0.86, p < 0.001) and agreement [mean difference 0.024, 95% limits of agreement (LoA): −0.11, 0.15]. Similarly, post-stenting FFRB (mean 0.84 ± 0.10) and FFR (mean 0.86 ± 0.08) exhibited fair correlation (r = 0.50, p < 0.001) and good agreement (mean difference 0.024, 95% LoA: −0.20, 0.16). The accuracy of FFRB for identifying post-stenting ischemic lesions (FFR ≤ 0.8) (residual ischemia) was 87% (sensitivity 80%, specificity 88%). Our novel FFRB, based on CTCA with reduced-order CFD and resistance boundary conditions, accurately predicts the hemodynamic effects of stenting which may serve as a tool in PCI planning.

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Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions

Cited by 14 publications

References 38 publications

Comparison of 1D and 3D Models for the Estimation of Fractional Flow Reserve

Comparison of 1D and 3D Models for the Estimation of Fractional Flow Reserve

Impact of coronary plaque geometry on plaque vulnerability and its association with the risk of future cardiovascular events in patients with chest pain undergoing coronary computed tomographic angiography—the GEOMETRY study

Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention

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