One-Dimensional Mathematical Model-Based Automated Assessment of Fractional Flow Reserve in a Patient with Silent Myocardial Ischemia

Abstract

Patient: Male, 58Final Diagnosis: Coronary artery disease • silent myocardial ischemiaSymptoms: Silent myocardial ischemiaMedication: —Clinical Procedure: Noninvasive assessmant of fractional flow reserve • left descening artery revascularizationSpecialty: CardiologyObjective:Unusual setting of medical careBackground:Noninvasive assessment of the fractional flow reserve (FFR) in patients with coronary artery disease plays an important role in determining the need for revascularization. It is particularly relevant for patients with a borderline stenoses and painless myocardial ischemia. Our article describes the first clinical experience in the Russian Federation of using an automated method of noninvasive assessment of the fractional flow reserve (FFRct) with a one-dimensional (1-D) mathematical model in a patient with painless myocardial ischemia.Case Report:A 58-year-old male patient who underwent stent implantation in the left circumflex coronary artery (LCX) due to an acute non-ST-elevation posterior myocardial infarction had borderline stenoses of the left anterior descending artery (LAD). After stent implantation, there were no relapse angina symptoms on drug treatment, and according to our examination guideline for patients with borderline stenoses, a treadmill test was performed. The test was positive; therefore, FFR assessment was recommended, with coronary multi-slice CT being performed. The following results were obtained: FFRct LAD – 0.57; FFRct LCX – 0.88. An invasive assessment of FFR was also performed as a reference standard and revealed: FFR LAD – 0.6; FFR LCX – 0.88, and simultaneously a LAD percutaneous coronary intervention (PCI) was performed. Three months later, the patient underwent a stress test, which revealed no evidence of induced ischemia.Conclusions:Our method of noninvasive assessment of FFR has shown encouraging results, but we believe that larger-scale studies are needed to establish it as common clinical practice.

Early Diagnosis of Intracranial Internal Carotid Artery Stenosis Using Extracranial Hemodynamic Indices from Carotid Doppler Ultrasound

“…Their simulation analyses validated the efficiency of 1D models. Similar studies have validated the accuracy of 1D models with stenosis [ 19 , 20 , 21 ].…”

Mathematical modelling of atherosclerosis

“…The other parameters are set according to wellknown physiologically correct ranges for selected groups classified by age, body mass index, smoking and alcohol consumption, lifestyle, etc. The 1D models are capable to predict FFR with acceptable accuracy and are suitable for the bedside applications [31,[77][78][79]. Moreover, these models can be used in multistenotic vasculatures where the classical FFR definition is not applicable: even the case of two successive stenoses has another FFR formula [148].…”

Modern methods of mathematical modeling of blood flow using reduced order methods

“…В связи с этим крайне важным является требование использования параметров, измеряемых регулярными методами диагностики. Существующие пациентоориентированные модели вполне успешно справляются с такими задачами, как моделирование церебрального кровотока [Alastruey et al, 2008;Liang et al, 2011;Spronck et al, 2012], коронарного кровотока [Zhang et al, 2015;, в том числе фракционированного резерва кровотока (ФРК) [Gamilov et al, 2015;Gognieva et al, 2018]. Численное моделирование ФРК на основе неинвазивно измеряемых данных имеет большое практическое значение в кардиологии при анализе показаний к стентированию коронарных артерий, поскольку позволяет избежать дорогостоящего внутрисосудистого вмешательства и дает принципиально новые возможности для виртуального анализа многососудистого поражения и интенсивного кровотока, недоступные при традиционном клиническом обследовании.…”