Fractional Flow Reserve Calculation From 3-Dimensional Quantitative Coronary Angiography and TIMI Frame Count

Tu, Shengxian; Barbato, Emanuele; Kõszegi, Zsolt; Yang, Jing; Sun, Zhonghua; Holm, Niels Ramsing; Tar, Balázs; Li, Yingguang; Ruşinaru, Dan; Wijns, William; Reiber, Johan H. C.

doi:10.1016/j.jcin.2014.03.004

Cited by 310 publications

(152 citation statements)

References 18 publications

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“…12,13 Recently, 3-dimensional (3D) quantitative coronary angiography (QCA)-based FFR evaluation (FFR QCA ) proved to be a promising tool for evaluating the functional significance of intermediate coronary stenosis during diagnostic coronary angiography. 14 The objective of this study was to present a new approach for estimating invasive FFR using OCT lumen contour-based 3D coronary models (FFR OCT ) and CFD algorithms. In addition, the clinical usefulness of FFR OCT was evaluated with pressure wire-based FFR in patients with ambiguous intermediate diameter stenosis in the left anterior descending artery.…”

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confidence: 99%

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Kim

Lim

et al. 2016

Circ: Cardiovascular Interventions

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Background-Intravascular optical coherence tomography (OCT) imaging provides limited information on the functional assessment of coronary stenosis. We evaluated a new approach to OCT image-based computation modeling, which can be used to estimate the fractional flow reserve (FFR) 14 The objective of this study was to present a new approach for estimating invasive FFR using OCT lumen contour-based 3D coronary models (FFR OCT ) and CFD algorithms. In addition, the clinical usefulness of FFR OCT was evaluated with pressure wire-based FFR in patients with ambiguous intermediate diameter stenosis in the left anterior descending artery. MethodsA total of 100 consecutive patients who underwent both OCT and FFR evaluation of intermediate stenosis in the left anterior descending artery between November 2013 and January 2015 were retrospectively enrolled. Eight patients were excluded because of poor reconstruction of the 3D OCT images. A total of 92 patients were finally included in the analysis. The inclusion criteria included (1) clinical presentation of angina, (2) intermediate diameter stenosis (40%-70%) in de novo lesions proximal to the mid-portion of the left anterior descending artery, and (3) visual angiographic lesions of <20 mm in length. The exclusion criteria included: (1) clinical presentation of acute myocardial infarction, (2) previous history of myocardial infarction, (3) presence of regional wall motion abnormality in the territory of the left anterior descending artery, (4) significant stenosis (≥50% diameter stenosis) distal to the target lesion, (5) angiographic thrombus, and (6) contraindication to adenosine. This study was approved by the institutional review board at our institution. Written informed consent was obtained from all patients.An off-line quantitative coronary angiographic system (CAAS system; Pie Medical Instruments, Maastricht, Netherlands) was used to perform QCA analysis in an independent core laboratory (Cardiovascular Research Center, Seoul, Korea). Using the guiding catheter for magnification calibration, the reference vessel diameter and minimum luminal diameter (MLD) were measured from diastolic frames in a single, matched view showing the smallest MLD ( Figure 1A). OCT Imaging and Reconstruction of 3D Coronary Artery GeometryTarget lesion imaging was performed using a frequency-domain OCT system (C7-XR OCT imaging system; LightLab Imaging, Inc./ St. Jude Medical, St. Paul, MN). The OCT cross-sectional images were generated at a rotational speed of 100 frames/s. The fiber probe was withdrawn at 20 mm/s within the stationary imaging sheath. All OCT images were analyzed at the core laboratory (Cardiovascular Research Center) by analysts who were blinded to patient and procedural information. The minimal luminal area (MLA) was identified at the segment with the smallest lumen area by OCT analysis. Area stenosis was calculated as follows: [(mean reference lumen area−minimum lumen area)÷mean reference lumen area] ×100. The reference lumen area was the region within the same segme...

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mentioning

confidence: 99%

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Kim

Lim

et al. 2016

Circ: Cardiovascular Interventions

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“…6 QFR showed a direct correlation (r=0.81, P<0.001) and good agreement (mean difference: 0.00±0.06, P=0.541) with FFR. 6 The accuracy of QFR for predicting FFR ≤0.80 was 88%, with positive and negative predictive values of 82% and 91%, respectively. 6 In addition, subsequent studies showed that QFR (i.e., fQFR, cQFR and adenosine-flow QFR [measured hyperemic flow velocity derived from angiography during adenosine-induced descending (LAD) coronary artery did not alter the results for the diagnostic performance of QFR ≤0.80 for predicting FFR ≤0.80 (Table 4).…”

Section: Qfr Vs Ffrmentioning

confidence: 91%

“…Recent studies have demonstrated good correlation between QFR and FFR. [6][7][8] Mismatch between angiographic diameter stenosis and FFR is often observed in prior myocardial infarction (MI)-the coronary artery with the most severe stenotic lesion as the target vessel. Prior MI was defined by the following criteria: (1) …”

Section: Study Populationmentioning

confidence: 99%

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

Emori

Kubo

Kameyama

et al. 2018

Circ J

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related coronary arteries. Angiographically severe stenoses in prior-MI-related coronary arteries are not necessary to induce myocardial ischemia because the amount of viable myocardium is reduced. 9-11 Previous studies have demonstrated that FFR can accurately assess the degree of ischemia even in prior-MI-related coronary arteries, 11,12 but QFR may not consider the amount of viable myocardium because this index is estimated from the anatomic information of the epicardial coronary artery. Therefore, we investigated the diagnostic accuracy of QFR in prior-MI-related coronary arteries as compared with FFR. Methods Study PopulationThe present study was a retrospective, single-center study of patients who underwent CAG and FFR. We analyzed a consecutive series of 75 prior-MI-related coronary arteries (examined in 75 patients between July 2012 and December 2016) and a consecutive series of 75 non-prior-MI-related F ractional flow reserve (FFR) is a useful index of the functional significance of a coronary stenosis. 1 It is obtained during routine coronary angiography (CAG) by using a pressure wire. 2 FFR is independent of heart rate, systemic blood pressure and cardiac output and takes into account myocardial territory and viability and collateral perfusion. 2-5 However, FFR has some disadvantages, such as risks of pressure wire injury, side effects of hyperemic agents and additional costs.Quantitative flow ratio (QFR) is a novel approach to assessing the functional severity of a coronary stenosis. It is calculated from 3D quantitative CAG (3D-QCA) using an advanced algorithm that enables fast computation of the pressure drop caused by coronary stenosis.

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“…Recently, high-resolution OCT imaging has been used to calculate coronary hemodynamics in image-based simulation models [6–10]. In these studies, the local region of interest (ROI) of the coronary artery, scanned using OCT, was merged into a rough 3D coronary arterial model reconstructed from biplane CAG images [10–14].…”

Section: Introductionmentioning

confidence: 99%

A vessel length-based method to compute coronary fractional flow reserve from optical coherence tomography images

Lee

Shin

et al. 2017

BioMed Eng OnLine

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BackgroundHemodynamic simulation for quantifying fractional flow reserve (FFR) is often performed in a patient-specific geometry of coronary arteries reconstructed from the images from various imaging modalities. Because optical coherence tomography (OCT) images can provide more precise vascular lumen geometry, regardless of stenotic severity, hemodynamic simulation based on OCT images may be effective. The aim of this study is to perform OCT–FFR simulations by coupling a 3D CFD model from geometrically correct OCT images with a LPM based on vessel lengths extracted from CAG data with clinical validations for the present method.MethodsTo simulate coronary hemodynamics, we developed a fast and accurate method that combined a computational fluid dynamics (CFD) model of an OCT-based region of interest (ROI) with a lumped parameter model (LPM) of the coronary microvasculature and veins. Here, the LPM was based on vessel lengths extracted from coronary X-ray angiography (CAG) images. Based on a vessel length-based approach, we describe a theoretical formulation for the total resistance of the LPM from a three-dimensional (3D) CFD model of the ROI.ResultsTo show the utility of this method, we present calculated examples of FFR from OCT images. To validate the OCT-based FFR calculation (OCT–FFR) clinically, we compared the computed OCT–FFR values for 17 vessels of 13 patients with clinically measured FFR (M-FFR) values.ConclusionA novel formulation for the total resistance of LPM is introduced to accurately simulate a 3D CFD model of the ROI. The simulated FFR values compared well with clinically measured ones, showing the accuracy of the method. Moreover, the present method is fast in terms of computational time, enabling clinicians to provide solutions handled within the hospital.

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Fractional Flow Reserve Calculation From 3-Dimensional Quantitative Coronary Angiography and TIMI Frame Count

Abstract: Computation of FFRQCA is a novel method that allows the assessment of the functional significance of intermediate stenosis. It may emerge as a safe, efficient, and cost-reducing tool for evaluation of coronary stenosis severity during diagnostic angiography.

Cited by 310 publications

References 18 publications

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Assessing Computational Fractional Flow Reserve From Optical Coherence Tomography in Patients With Intermediate Coronary Stenosis in the Left Anterior Descending Artery

Diagnostic Accuracy of Quantitative Flow Ratio for Assessing Myocardial Ischemia in Prior Myocardial Infarction

A vessel length-based method to compute coronary fractional flow reserve from optical coherence tomography images

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