"Less Invasive" Fractional Flow Reserve Measurement From 3-Dimensional Quantitative Coronary Angiography and Classic Fluid Dynamic Equations

Tar, Balazs and Jenei, Csaba and Dézsi, Csaba András and Bakk, Sandor and Beres, Zoltan and Santa, Janos and Svab, Marianna and Szentes, Veronika and Polgár, Péter and Bujaky, Csaba and Czuriga, Dániel and Kőszegi, Zsolt (2018) "Less Invasive" Fractional Flow Reserve Measurement From 3-Dimensional Quantitative Coronary Angiography and Classic Fluid Dynamic Equations. Eurointervention, 14 (8). pp. 942-950. ISSN 1774-024X, ESSN: 1969-6213 (In Press)

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Abstract

Aims: To develop a simplified model of FFR calculation (FFRsim) deriving from 3-dimensional (3D) coronary angiographic data and classic fluid dynamic equations without using finite element analysis. Methods and results: Intracoronary pressure measurements were performed by pressure wire sensors. Lumens of the interrogated vessel segments were reconstructed in 3D. The coronary artery volumetric flow was calculated based on the velocity of the contrast material. Pressure gradients were computed by classic fluid dynamic equations. The diagnostic power of the simplified computation of the FFR (FFRsim) was assessed by comparing the results with standard invasive FFR measurements (FFRmeas) in 68 vessels with single stenosis. We found a strong correlation between the FFRsim and the FFRmeas (r=0.86, p<0.0001). The sensitivity and specificity for predicting the abnormal FFR of ≤0.80 (indicating hemodynamically significant stenosis) were 90 % and 100 %, respectively. The area under the curve (AUC) was 0.96. To achieve 100% negative and positive predictive value we defined the FFRsim > 0.88 and the FFRsim ≤ 0.8 ranges. In our patient population, these ranges were found in 69% of the cases. Conclusions: According to our simplified model the invasive FFR measurement can be omitted without misclassification in pre-specified ranges of the calculated FFRsim.

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