151
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Chu M, Gutiérrez-Chico JL, Li Y, Holck EN, Zhang S, Huang J, Li Z, Chen L, Christiansen EH, Dijkstra J, Holm NR, Tu S. Effects of local hemodynamics and plaque characteristics on neointimal response following bioresorbable scaffolds implantation in coronary bifurcations. Int J Cardiovasc Imaging 2019; 36:241-249. [PMID: 31667662 DOI: 10.1007/s10554-019-01721-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
Abstract
Heterogeneous neointimal response has been observed after implantation of all generations of coronary stents. Our aim was assessing local factors of shear stress (SS) and plaque characteristics in neointimal response after implantation of bioresorbable scaffolds (BRS) in bifurcations. Ten patients from the BIFSORB pilot study were analysed. Follow-up optical frequency domain imaging (OFDI) was performed at 1 month and 2 years. Coronary lumen and BRS structure were reconstructed by fusion of OFDI and angiography and were used for subsequent flow simulation. Plaque arc degree and SS were quantified using post-procedural OFDI data and were matched with follow-up OFDI using anatomical landmarks. Strut-level and segment-level analysis were performed for 1-month and 2-year follow-up respectively. A total of 444 struts (54 jailing struts) were included at 1-month follow-up. Time-average SS (TASS) was significantly lower for covered struts than for uncovered struts in non-bifurcation segments (TASS: 1.81 ± 1.87 vs. 3.88 ± 3.72 Pa, p < 0.001). The trend remained the same for jailing struts, although statistically insignificant (TASS: 10.85 ± 13.12 vs. 13.64 ± 14.48 Pa, p = 0.328). For 2-year follow-up, a total of 66 sub-regions were analysed. Neointimal hyperplasia area (NTA) was negatively correlated with TASS in core-segments (ρ = - 0.389, p = 0.037) and positively correlated with plaque arc degree in non-core segments (ρ = 0.387, p = 0.018). Slightly stronger correlations with NTA were observed when combining TASS and plaque arc degree in both core segments (ρ = - 0.412, p = 0.026) and non-core segments (ρ = - 0.395, p = 0.015). Hemodynamic microenvironment and baseline plaque characteristics may regulate neointimal response after BRS implantation in bifurcation. These findings underline the combined role of plaque characteristics and local hemodynamics in vessel healing after stent implantation.
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Affiliation(s)
- Miao Chu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People's Republic of China.,Department of Cardiology, Campo de Gibraltar Health Trust, Algeciras (Cádiz), Spain
| | | | - Yingguang Li
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Su Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People's Republic of China
| | - Jiayue Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People's Republic of China
| | - Zehang Li
- School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People's Republic of China
| | - Lianglong Chen
- Department of Cardiology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | | | - Jouke Dijkstra
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Room 123, No. 1954, Huashan Road, Shanghai, 200030, People's Republic of China.
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152
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Yoshikawa Y, Nakamoto M, Nakamura M, Hoshi T, Yamamoto E, Imai S, Kawase Y, Okubo M, Shiomi H, Kondo T, Matsuo H, Kimura T, Saito N. On-site evaluation of CT-based fractional flow reserve using simple boundary conditions for computational fluid dynamics. Int J Cardiovasc Imaging 2019; 36:337-346. [PMID: 31628575 DOI: 10.1007/s10554-019-01709-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
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153
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Quantitative flow ratio and instantaneous wave-free ratio for the assessment of the functional severity of intermediate coronary artery stenosis. Coron Artery Dis 2019; 29:611-617. [PMID: 29965837 DOI: 10.1097/mca.0000000000000650] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Quantitative flow ratio (QFR) is a novel physiological index of the severity of coronary stenosis. The aim of the present study was to investigate the relationship between QFR and the instantaneous wave-free ratio (iFR). PATIENTS AND METHODS We analyzed contrast-flow QFR, iFR, and fractional flow reserve (FFR) in 100 coronary arteries with intermediate stenosis. RESULTS There was a high correlation (r=0.71, P<0.001) and a good agreement (mean difference: -0.09±0.11) between QFR and iFR. Both QFR and iFR were correlated significantly with FFR (r=0.89, P<0.001 and r=0.76, P<0.001, respectively). The mean absolute difference between FFR and QFR was significantly smaller than that between FFR and iFR (-0.01±0.07 vs. -0.08±0.09, P<0.001). The diagnostic accuracy of QFR less than or equal to 0.80 for predicting FFR less than or equal to 0.80 was numerically higher than that of iFR less than or equal to 0.89 for predicting FFR less than or equal to 0.80 [QFR: 94% (95% confidence interval: 85-97%) vs. iFR: 74% (95% confidence interval: 65-81%)]. CONCLUSION QFR was correlated highly with iFR as well as FFR. Like FFR and iFR, QFR might be reliable for assessing the physiological severity of coronary stenosis in the angiographic intermediate lesions.
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154
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Carson JM, Pant S, Roobottom C, Alcock R, Javier Blanco P, Alberto Bulant C, Vassilevski Y, Simakov S, Gamilov T, Pryamonosov R, Liang F, Ge X, Liu Y, Nithiarasu P. Non-invasive coronary CT angiography-derived fractional flow reserve: A benchmark study comparing the diagnostic performance of four different computational methodologies. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3235. [PMID: 31315158 PMCID: PMC6851543 DOI: 10.1002/cnm.3235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 05/05/2023]
Abstract
Non-invasive coronary computed tomography (CT) angiography-derived fractional flow reserve (cFFR) is an emergent approach to determine the functional relevance of obstructive coronary lesions. Its feasibility and diagnostic performance has been reported in several studies. It is unclear if differences in sensitivity and specificity between these studies are due to study design, population, or "computational methodology." We evaluate the diagnostic performance of four different computational workflows for the prediction of cFFR using a limited data set of 10 patients, three based on reduced-order modelling and one based on a 3D rigid-wall model. The results for three of these methodologies yield similar accuracy of 6.5% to 10.5% mean absolute difference between computed and measured FFR. The main aspects of modelling which affected cFFR estimation were choice of inlet and outlet boundary conditions and estimation of flow distribution in the coronary network. One of the reduced-order models showed the lowest overall deviation from the clinical FFR measurements, indicating that reduced-order models are capable of a similar level of accuracy to a 3D model. In addition, this reduced-order model did not include a lumped pressure-drop model for a stenosis, which implies that the additional effort of isolating a stenosis and inserting a pressure-drop element in the spatial mesh may not be required for FFR estimation. The present benchmark study is the first of this kind, in which we attempt to homogenize the data required to compute FFR using mathematical models. The clinical data utilised in the cFFR workflows are made publicly available online.
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Affiliation(s)
- Jason Matthew Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
| | - Sanjay Pant
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
| | - Carl Roobottom
- Derriford Hospital and Peninsula Medical SchoolPlymouth Hospitals NHS TrustPlymouthUK
| | - Robin Alcock
- Derriford Hospital and Peninsula Medical SchoolPlymouth Hospitals NHS TrustPlymouthUK
| | - Pablo Javier Blanco
- Department of Mathematical and Computational MethodsNational Laboratory for Scientific Computing, LNCC/MCTICPetrópolisBrazil
| | | | - Yuri Vassilevski
- Marchuk Institute of Numerical MathematicsRussian Academy of SciencesMoscowRussia
- Laboratory of Human PhysiologyMoscow Institute of Physics and TechnologyMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Sergey Simakov
- Laboratory of Human PhysiologyMoscow Institute of Physics and TechnologyMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Timur Gamilov
- Laboratory of Human PhysiologyMoscow Institute of Physics and TechnologyMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Roman Pryamonosov
- Marchuk Institute of Numerical MathematicsRussian Academy of SciencesMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Fuyou Liang
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
- School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Xinyang Ge
- School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Yue Liu
- School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Perumal Nithiarasu
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
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155
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Kogame N, Takahashi K, Tomaniak M, Chichareon P, Modolo R, Chang CC, Komiyama H, Katagiri Y, Asano T, Stables R, Fath-Ordoubadi F, Walsh S, Sabaté M, Davies JE, Piek J, van Geuns RJ, Reiber JH, Banning AP, Escaned J, Farooq V, Serruys PW, Onuma Y. Clinical Implication of Quantitative Flow Ratio After Percutaneous Coronary Intervention for 3-Vessel Disease. JACC Cardiovasc Interv 2019; 12:2064-2075. [DOI: 10.1016/j.jcin.2019.08.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
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156
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QFR Versus FFR Derived From Computed Tomography for Functional Assessment of Coronary Artery Stenosis. JACC Cardiovasc Interv 2019; 12:2050-2059. [DOI: 10.1016/j.jcin.2019.06.043] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 11/24/2022]
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157
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Mejía-Rentería H, Lauri FM, Lee JM, McInerney A, van der Hoeven NW, de Waard GA, Fernández-Ortiz A, Macaya C, Knaapen P, van Royen N, Koo BK, Escaned J. Interindividual Variations in the Adenosine-Induced Hemodynamics During Fractional Flow Reserve Evaluation: Implications for the Use of Quantitative Flow Ratio in Assessing Intermediate Coronary Stenoses. J Am Heart Assoc 2019; 8:e012906. [PMID: 31394987 PMCID: PMC6759899 DOI: 10.1161/jaha.119.012906] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Quantitative flow ratio (QFR), a novel functional angiography technique, computes fractional flow reserve (FFR) without pressure wires or adenosine. We investigated interindividual variations in the adenosine-induced hemodynamics during FFR assessment and their influence on QFR diagnostic performance. Methods and Results Patients with coronary stenoses who underwent intracoronary pressure and flow assessment were analyzed. Adenosine-induced hemodynamics during FFR measurement were determined by the percentage change in mean aortic pressure (%ΔPa) and the resistive reserve ratio (RRR). The diagnostic performance of QFR was evaluated and compared in each tertile of %ΔPa and RRR using FFR as reference. A total of 294 vessels (245 patients) were analyzed. Mean FFR was 0.80±0.11. Individuals showed a wide variation in the adenosine response in terms of %ΔPa (ranging from -75% to 43%; median, -9% [interquartile range, -3% to -17%]) and the RRR (ranging from 0.45 to 20.15; median, 3.1 [interquartile range, 2.1-4.9]). No significant differences for diagnostic efficiency of QFR were found between tertiles of %ΔPa (area under the curve for the receiver-operating characteristic analysis, 0.950 in tertile 1, 0.929 in tertile 2, and 0.910 in tertile 3; P=0.270) or between tertiles of the RRR (area under the curve for the receiver-operating characteristic analysis, 0.909 in tertile 1, 0.923 in tertile 2, and 0.959 in tertile 3; P=0.167). The classification agreement between QFR and FFR was not significantly modified by %ΔPa (tertile 1, 89%; tertile 2, 87%; and tertile 3, 86%; P=0.827) or by the RRR (tertile 1, 86%; tertile 2, 85%; and tertile 3, 91%; P=0.398). Conclusions Patients undergoing FFR assessment show large interindividual variations in the magnitude of adenosine-induced hemodynamics. However, such variations do not affect the diagnostic performance of QFR in assessing the functional relevance of observed stenoses.
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Affiliation(s)
| | | | - Joo Myung Lee
- Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Angela McInerney
- Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Spain
| | - Nina W van der Hoeven
- Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Spain.,Department of Cardiology VU University Medical Center Amsterdam the Netherlands
| | - Guus A de Waard
- Department of Cardiology VU University Medical Center Amsterdam the Netherlands
| | | | - Carlos Macaya
- Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Spain
| | - Paul Knaapen
- Department of Cardiology VU University Medical Center Amsterdam the Netherlands
| | - Niels van Royen
- Department of Cardiology VU University Medical Center Amsterdam the Netherlands
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,Institute on Aging Seoul National University Seoul Korea
| | - Javier Escaned
- Hospital Clínico San Carlos IDISSC and Universidad Complutense de Madrid Spain
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158
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Gutiérrez-Chico JL, Cortés C, Jaguszewski M, Schincariol M, Amat-Santos IJ, Franco-Peláez JA, Żuk G, Ciećwierz D, Wojakowski W, Navarro F, Tu S, Ibáñez B. A simplified formula to calculate fractional flow reserve in sequential lesions circumventing the measurement of coronary wedge pressure: The APIS-S pilot study. Cardiol J 2019; 26:310-321. [PMID: 31257567 DOI: 10.5603/cj.a2019.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 05/04/2019] [Accepted: 06/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen-tial coronary stenosis without balloon inflation is hereby proposed. METHODS In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu-la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls' formula. FFR of the remaining lesion was finally recorded (measured FFR). RESULTS Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls' formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640-0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. CONCLUSIONS The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.
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Affiliation(s)
- Juan Luis Gutiérrez-Chico
- Klinikum Frankfurt (Oder), Interventional Cardiology, Germany. .,Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany. .,DRK-Klinikum Westend, Berlin, Germany.
| | - Carlos Cortés
- Klinikum Frankfurt (Oder), Interventional Cardiology, Germany.,CIBERCV Hospital Clínico Universitario de Valladolid, ICICOR, Spain
| | - Miłosz Jaguszewski
- Klinikum Frankfurt (Oder), Interventional Cardiology, Germany.,Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany.,First Department of Cardiology, Medical University of Gdansk, Poland
| | - Michele Schincariol
- Institute of Cardiovascular Translational Research of Atlantic (ICTRA), Berlin, Germany
| | | | | | - Grzegorz Żuk
- First Department of Cardiology, Medical University of Gdansk, Poland
| | - Dariusz Ciećwierz
- First Department of Cardiology, Medical University of Gdansk, Poland
| | | | - Felipe Navarro
- IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.,CIBERCV, Madrid, Spain
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Borja Ibáñez
- IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain.,CIBERCV, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
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159
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Applicability of quantitative flow ratio for rapid evaluation of intermediate coronary stenosis: comparison with instantaneous wave-free ratio in clinical practice. Int J Cardiovasc Imaging 2019; 35:1963-1969. [DOI: 10.1007/s10554-019-01656-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 06/19/2019] [Indexed: 12/17/2022]
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160
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Vardhan M, Gounley J, Chen SJ, Kahn AM, Leopold JA, Randles A. The importance of side branches in modeling 3D hemodynamics from angiograms for patients with coronary artery disease. Sci Rep 2019; 9:8854. [PMID: 31222111 PMCID: PMC6586809 DOI: 10.1038/s41598-019-45342-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022] Open
Abstract
Genesis of atherosclerotic lesions in the human arterial system is critically influenced by the fluid mechanics. Applying computational fluid dynamic tools based on accurate coronary physiology derived from conventional biplane angiogram data may be useful in guiding percutaneous coronary interventions. The primary objective of this study is to build and validate a computational framework for accurate personalized 3-dimensional hemodynamic simulation across the complete coronary arterial tree and demonstrate the influence of side branches on coronary hemodynamics by comparing shear stress between coronary models with and without these included. The proposed novel computational framework based on biplane angiography enables significant arterial circulation analysis. This study shows that models that take into account flow through all side branches are required for precise computation of shear stress and pressure gradient whereas models that have only a subset of side branches are inadequate for biomechanical studies as they may overestimate volumetric outflow and shear stress. This study extends the ongoing computational efforts and demonstrates that models based on accurate coronary physiology can improve overall fidelity of biomechanical studies to compute hemodynamic risk-factors.
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Affiliation(s)
- Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA
| | - John Gounley
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA
| | - S James Chen
- Department of Medicine/Cardiology, University of Colorado AMC, Aurora, 80045, USA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, 92103, USA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, 02115, USA
| | - Amanda Randles
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA.
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161
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Wu X, von Birgelen C, Zhang S, Ding D, Huang J, Tu S. Simultaneous evaluation of plaque stability and ischemic potential of coronary lesions in a fluid-structure interaction analysis. Int J Cardiovasc Imaging 2019; 35:1563-1572. [PMID: 31053979 DOI: 10.1007/s10554-019-01611-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 04/23/2019] [Indexed: 01/31/2023]
Abstract
The measurement of fractional flow reserve (FFR) and superficial wall stress (SWS) identifies inducible myocardial ischemia and plaque vulnerability, respectively. A simultaneous evaluation of both FFR and SWS is still lacking, while it may have a major impact on therapy. A new computational model of one-way fluid-structure interaction (FSI) was implemented and used to perform a total of 54 analyses in virtual coronary lesion models, based on plaque compositions, arterial remodeling patterns, and stenosis morphologies under physiological conditions. Due to a greater lumen dilation and more induced strain, FFR in the lipid-rich lesions (0.81 ± 0.15) was higher than that in fibrous lesions (0.79 ± 0.16, P = 0.001) and calcified lesions (0.79 ± 0.16, P = 0.001). Four types of lesions were further defined, based on the combination of cutoff values for FFR (0.80) and maximum relative SWS (30 kPa): The level of risk increased from (1) plaques with mild-to-moderate stenosis but negative remodeling for lipid-rich (Type A: non-ischemic, stable) to (2) lipid-rich plaques with mild-to-moderate stenosis and without-to-positive remodeling (Type B: non-ischemic, unstable) or plaques with severe stenosis but negative remodeling for lipid-rich (Type C: ischemic, stable) to (3) lipid-rich plaques with severe stenosis and without-to-positive remodeling (Type D: ischemic, unstable). The analysis of FSI to simultaneously evaluate inducible myocardial ischemia and plaque stability may be useful to identify coronary lesions at a high risk and to ultimately optimize treatment. Further research is warranted to assess whether a more aggressive treatment may improve the prognosis of patients with non-ischemic, intermediate, and unstable lesions.
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Affiliation(s)
- Xinlei Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | | | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayue Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China. .,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
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162
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Influence of Microcirculatory Dysfunction on Angiography-Based Functional Assessment of Coronary Stenoses. JACC Cardiovasc Interv 2019; 11:741-753. [PMID: 29673505 DOI: 10.1016/j.jcin.2018.02.014] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The authors sought to evaluate the influence of coronary microcirculatory dysfunction (CMD) on the diagnostic performance of the quantitative flow ratio (QFR). BACKGROUND Functional angiographic assessment of coronary stenoses based on fluid dynamics, such as QFR, constitutes an attractive alternative to fractional flow reserve (FFR). However, it is unknown whether CMD affects the reliability of angiography-based functional indices. METHODS FFR and the index of microcirculatory resistance (IMR) were measured in 300 vessels (248 patients) as part of a multicenter international registry. QFR was calculated at a blinded core laboratory. Vessels were classified into 2 groups according to microcirculatory status: low IMR (<23 U), and high IMR (≥23 U, CMD). The impact of CMD on the diagnostic performance of QFR, as well as on incremental value of QFR over quantitative angiography, was assessed using FFR as reference. RESULTS Percent diameter stenosis (%DS) and FFR were similar in low- and high-IMR groups (%DS 51 ± 12% vs. 53 ± 11%; p = 0.16; FFR 0.80 ± 0.11 vs. 0.81 ± 0.11; p = 0.23, respectively). In the overall cohort, classification agreement (CA) between QFR and FFR and diagnostic efficiency of QFR (area under the receiver-operating characteristics curve [AUC]) were high (CA: 88%; AUC: 0.93 [95% confidence interval (CI): 0.90 to 0.96]). However, when assessed according to microcirculatory status, a significantly lower CA and AUC of QFR were found in the high-IMR group as compared with the low-IMR group (CA: 76% vs. 92%; p < 0.001; AUC: 0.88 [95% CI: 0.79 to 0.94] vs. 0.96 [95% CI: 0.92 to 0.98]; p < 0.05). Compared with angiographic assessment, QFR increased by 0.20 (p < 0.001) and by 0.16 (p < 0.001) the AUC of %DS in low- and high-IMR groups, respectively. Independent predictors of misclassification between QFR and FFR were high IMR and acute coronary syndrome. CONCLUSIONS CMD decreases the diagnostic performance of QFR. However, even in the presence of CMD, QFR remains superior to angiography alone in ascertaining functional stenosis severity.
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163
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Siogkas PK, Papafaklis MI, Lakkas L, Exarchos TP, Karmpaliotis D, Ali ZA, Pelosi G, Parodi O, Katsouras CS, Fotiadis DI, Michalis LK. Virtual Functional Assessment of Coronary Stenoses Using Intravascular Ultrasound Imaging: A Proof-of-Concept Pilot Study. Heart Lung Circ 2019; 28:e33-e36. [PMID: 29895487 DOI: 10.1016/j.hlc.2018.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/19/2017] [Accepted: 02/11/2018] [Indexed: 11/27/2022]
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164
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Zaleska M, Kołtowski Ł, Maksym J, Tomaniak M, Opolski M, Kochman J. Alternative methods for functional assessment of intermediate coronary lesions. Cardiol J 2019; 27:825-835. [PMID: 30912574 PMCID: PMC8079099 DOI: 10.5603/cj.a2019.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/27/2018] [Accepted: 01/21/2019] [Indexed: 01/10/2023] Open
Abstract
Wire-based fractional flow reserve (FFR) is a diagnostic tool used to evaluate the ischemic burden of coronary lesions. Large-scale studies have shown that FFR-guided revascularization is associated with better clinical outcomes. However, wide adoption of this technology is limited due to the considerable cost, additional time needed for set-up and performance of the measurement as well as the invasiveness of the procedure which requires pressure wire placement across the lesion into the distal segment of the coronary artery. To overcome these limitations new, promising, and less-/non-invasive methods were developed. These methods are based on computational fluid dynamics analysis and three-dimensional lumen reconstruction. The aim of this paper is to review scientific evidence supporting the clinical safety and efficacy of these techniques, such as instantaneous wave-free ratio, quantitative flow ratio and FFR calculated from computed tomographic angiography.
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Affiliation(s)
- Martyna Zaleska
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
| | - Łukasz Kołtowski
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland.
| | - Jakub Maksym
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
| | - Mariusz Tomaniak
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
| | - Maksymilian Opolski
- Department of Interventional Cardiology and Angiology, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Janusz Kochman
- First Chair and Department of Cardiology, Medical University of Warsaw, Poland, Poland
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165
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Evaluation of fractional flow reserve in patients with stable angina: can CT compete with angiography? Eur Radiol 2019; 29:3669-3677. [DOI: 10.1007/s00330-019-06023-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/20/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
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166
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Asano T, Katagiri Y, Chang CC, Kogame N, Chichareon P, Takahashi K, Modolo R, Tenekecioglu E, Collet C, Jonker H, Appleby C, Zaman A, van Mieghem N, Uren N, Zueco J, Piek JJ, Reiber JH, Farooq V, Escaned J, Banning AP, Serruys PW, Onuma Y. Angiography-Derived Fractional Flow Reserve in the SYNTAX II Trial. JACC Cardiovasc Interv 2019; 12:259-270. [DOI: 10.1016/j.jcin.2018.09.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/03/2018] [Accepted: 09/17/2018] [Indexed: 12/22/2022]
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167
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Papafaklis MI, Baumbach A. From Lumenogram to "Functional Angiography" and the Evolution of Virtual Fractional Flow Reserve. Circulation 2019; 139:485-488. [PMID: 30586782 DOI: 10.1161/circulationaha.118.037528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Andreas Baumbach
- Barts Heart Centre, St Bartholomew's Hospital, London, UK (M.I.P., A.B.).,William Harvey Research Institute, Queen Mary University of London, UK (A.B.)
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168
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Automatic coronary blood flow computation: validation in quantitative flow ratio from coronary angiography. Int J Cardiovasc Imaging 2018; 35:587-595. [DOI: 10.1007/s10554-018-1506-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/16/2018] [Indexed: 11/25/2022]
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169
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Stähli BE, Erbay A, Steiner J, Klotsche J, Mochmann HC, Skurk C, Lauten A, Landmesser U, Leistner DM. Comparison of resting distal to aortic coronary pressure with angiography-based quantitative flow ratio. Int J Cardiol 2018; 279:12-17. [PMID: 30545620 DOI: 10.1016/j.ijcard.2018.11.093] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel, adenosine-free method for functional coronary lesion interrogation, which is based on 3-dimensional quantitative coronary angiography and computational algorithms. Data on QFR in all-comer patients with intermediate coronary lesions are scarce, and the diagnostic performance in comparison to resting distal to aortic coronary pressure (Pd/Pa) ratio unknown. METHODS A total of 436 patients with 516 vessels undergoing FFR measurements were included in the analysis. Diagnostic performance of QFR, distal to aortic coronary pressure (Pd/Pa) ratio, and anatomic indices versus FFR was assessed. RESULTS FFR ≤0.80 was measured in 19.4% of interrogated vessels. QFR significantly correlated with FFR (r = 0.82, p < 0.001) with good agreement between QFR and FFR (mean difference 0.011, 95% CI 0.008-0.015). The AUC for an FFR ≤0.80 was 0.86 (95% CI 0.83-0.89, p < 0.001) for QFR, 0.76 (0.72-0.80, p < 0.001) for resting Pd/Pa ratio, and 0.63 (0.59-0.67, p < 0.001) for diameter stenosis. The diagnostic accuracy for identifying an FFR ≤0.80 was 93.4% for QFR, 84.3% for resting Pd/Pa ratio, and 80.4% for diameter stenosis. CONCLUSIONS QFR provides a novel diagnostic tool for functional coronary lesion assessment with superior diagnostic accuracy as compared with resting Pd/Pa ratio and anatomic indices. Future studies are needed to determine the non-inferiority of QFR analysis to FFR assessment with respect to clinical outcomes.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Aslihan Erbay
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Julia Steiner
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center Berlin, Berlin, Germany; Institute for Epidemiology and Health Care Economics, Charité Berlin - University Medicine, Campus Mitte, Berlin, Germany
| | - Hans-Christian Mochmann
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Carsten Skurk
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Alexander Lauten
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Ulf Landmesser
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - David M Leistner
- Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
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170
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Cesaro A, Gragnano F, Di Girolamo D, Moscarella E, Diana V, Pariggiano I, Alfieri A, Perrotta R, Golino P, Cesaro F, Mercone G, Campo G, Calabrò P. Functional assessment of coronary stenosis: an overview of available techniques. Is quantitative flow ratio a step to the future? Expert Rev Cardiovasc Ther 2018; 16:951-962. [DOI: 10.1080/14779072.2018.1540303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Arturo Cesaro
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Felice Gragnano
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Domenico Di Girolamo
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Elisabetta Moscarella
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Diana
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ivana Pariggiano
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Alfonso Alfieri
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Rocco Perrotta
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Pasquale Golino
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Francesco Cesaro
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Giuseppe Mercone
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Paolo Calabrò
- Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy
- Division of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
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171
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Tar B, Jenei C, Dezsi CA, Bakk S, Beres Z, Santa J, Svab M, Szentes V, Polgar P, Bujaky C, Czuriga D, Kőszegi Z. Less invasive fractional flow reserve measurement from 3-dimensional quantitative coronary angiography and classic fluid dynamic equations. EUROINTERVENTION 2018; 14:942-950. [DOI: 10.4244/eij-d-17-00859] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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172
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Chang Y, Chen L, Westra J, Sun Z, Guan C, Zhang Y, Ding D, Xu B, Tu S. Reproducibility of quantitative flow ratio: An inter-core laboratory variability study. Cardiol J 2018; 27:230-237. [PMID: 30234896 DOI: 10.5603/cj.a2018.0105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel approach to derive fractional flow reserve (FFR) from coronary angiography. This study sought to evaluate the reproducibility of QFR when analyzed in independent core laboratories. METHODS All interrogated vessels in the FAVOR II China Study were separately analyzed using the AngioPlus system (Pulse medical imaging technology, Shanghai) by two independent core laboratories, following the same standard operation procedures. The analysts were blinded to the FFR values and online QFR values. For each interrogated vessel, two identical angiographic image runs were used by two core laboratories for QFR computation. In both core laboratories QFR was successfully obtained in 330 of 332 vessels, in which FFR was available in 328 vessels. Thus, 328 vessels ended in the present statistical analysis. RESULTS The mean difference in contrast-flow QFR between the two core laboratories was 0.004 ± 0.03 (p = 0.040), which was slightly smaller than that between the online analysis and the two core laboratories (0.01 ± 0.05, p < 0.001 and 0.01 ± 0.05, p = 0.038). The mean difference of QFR with re-spect to FFR were comparable between the two core laboratories (0.002 ± 0.06, p = 0.609, and 0.002 ± 0.06, p = 0.531). Receiver operating characteristic curve analysis showed that diagnostic accuracies of QFR analyzed by the two core laboratories were both excellent (area under the curve: 0.970 vs. 0.963, p = 0.142), when using FFR as the reference standard. CONCLUSIONS The present study showed good inter-core laboratory reproducibility of QFR in assessing functionally-significant stenosis. It suggests that QFR analyses can be carried out in different core labo-ratories if, and only if, highly standardized conditions are maintained.
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Affiliation(s)
- Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Liwei Chen
- Department of Cardiology, Shin Kong Memorial Wu Ho-Su Hospital, Taipei, Taiwan
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Zhongwei Sun
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Yimin Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
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173
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Bezerra CG, Hideo-Kajita A, Bulant CA, Maso-Talou GD, Mariani J, Pinton FA, Falcão BAA, Esteves-Filho A, Franken M, Feijóo RA, Kalil-Filho R, Garcia-Garcia HM, Blanco PJ, Lemos PA. Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology. Catheter Cardiovasc Interv 2018; 93:266-274. [PMID: 30277641 DOI: 10.1002/ccd.27822] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/15/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUSFR ), compared to gold-standard invasive measurements (FFRINVAS ). BACKGROUND IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel. METHODS Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFRINVAS measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUSFR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFRINVAS measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions. RESULTS A total of 24 patients with 34 vessels were analyzed. IVUSFR significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFRINVAS , with a mean difference of -0.008 ± 0.067 (P = 0.47). IVUSFR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis. CONCLUSION The computational processing of IVUSFR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS.
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Affiliation(s)
- Cristiano G Bezerra
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil
| | - Alexandre Hideo-Kajita
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, District of Columbia.,Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Carlos A Bulant
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Gonzalo D Maso-Talou
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Jose Mariani
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Fabio A Pinton
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Breno A A Falcão
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Antônio Esteves-Filho
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Marcelo Franken
- Division of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Raúl A Feijóo
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Roberto Kalil-Filho
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Division of Cardiology, Sirio-Libanes Hospital, Sao Paulo, Brazil
| | - Hector M Garcia-Garcia
- MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, District of Columbia.,Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Pablo J Blanco
- National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil
| | - Pedro A Lemos
- Division of Interventional Cardiology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.,National Institute of Science and Technology in Medicine Assisted by Scientific Computing, INCT-MACC, São Paulo, Brazil.,Division of Cardiology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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174
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Collet C, Onuma Y, Sonck J, Asano T, Vandeloo B, Kornowski R, Tu S, Westra J, Holm NR, Xu B, de Winter RJ, Tijssen JG, Miyazaki Y, Katagiri Y, Tenekecioglu E, Modolo R, Chichareon P, Cosyns B, Schoors D, Roosens B, Lochy S, Argacha JF, van Rosendael A, Bax J, Reiber JHC, Escaned J, De Bruyne B, Wijns W, Serruys PW. Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis. Eur Heart J 2018; 39:3314-3321. [DOI: 10.1093/eurheartj/ehy445] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/31/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Yoshinobu Onuma
- Cardialysis BV, Rotterdam, The Netherlands
- Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
| | - Jeroen Sonck
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Taku Asano
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Belinson Hospital Affiliated to the “Sackler” Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Robbert J de Winter
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Jan G Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Yuki Katagiri
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Rodrigo Modolo
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ply Chichareon
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Daniel Schoors
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Bram Roosens
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | - Stijn Lochy
- Department of Cardiology, Universitair Ziekenhuis Brussel, Brussel, Belgium
| | | | | | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands
| | - Johan H C Reiber
- Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Medis Medical Imaging Systems, Leiden, The Netherlands
| | - Javier Escaned
- Hospital Clinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Saolta University Healthcare Group, Galway, Ireland
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175
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Quantitative flow ratio derived from diagnostic coronary angiography in assessment of patients with intermediate coronary stenosis: a wire-free fractional flow reserve study. Clin Res Cardiol 2018; 107:858-867. [DOI: 10.1007/s00392-018-1258-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/17/2018] [Indexed: 10/28/2022]
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176
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Han H, Bae YG, Hwang ST, Kim HY, Park I, Kim SM, Choe Y, Moon YJ, Choi JH. Computationally simulated fractional flow reserve from coronary computed tomography angiography based on fractional myocardial mass. Int J Cardiovasc Imaging 2018; 35:185-193. [DOI: 10.1007/s10554-018-1432-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
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177
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Ties D, van Dijk R, Pundziute G, Lipsic E, Vonck TE, van den Heuvel AFM, Vliegenthart R, Oudkerk M, van der Harst P. Computational quantitative flow ratio to assess functional severity of coronary artery stenosis. Int J Cardiol 2018; 271:36-41. [PMID: 30131233 DOI: 10.1016/j.ijcard.2018.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 04/17/2018] [Accepted: 05/02/2018] [Indexed: 11/18/2022]
Abstract
Background
Computational quantitative flow ratio (QFR) based on 3-dimensional quantitative coronary angiography (3D QCA) analysis offers the opportunity to assess the significance of coronary artery disease (CAD) without using an invasive pressure wire or inducing hyperemia. This study aimed to evaluate the diagnostic performance of QFR compared to wire-based fractional flow reserve (FFR) and to validate the previously reported QFR cut-off value of >0.90 to safely rule out functionally significant CAD.
Methods
QFR was retrospectively derived from standard-care coronary angiograms. Correlation and agreement of fixed-flow QFR (fQFR) and contrast-flow QFR (cQFR) models with invasive wire-based FFR was calculated. Diagnostic performance of QFR was evaluated at different QFR cut-off values defining significant CAD (FFR ≤ 0.80).
Results
101 vessels in 96 patients who underwent FFR were studied. Mean FFR was 0.87 ± 0.08 and 21 of 101 (21%) vessels had an FFR ≤ 0.80. Correlation of fQFR and cQFR with FFR was r = 0.71 (p < 0.001) and r = 0.70 (p < 0.001), respectively. Sensitivity and specificity were 57% and 93% for fQFR and 67% and 96% for cQFR at a QFR cut-off value >0.80 defining non-significant CAD, respectively. fQFR > 0.90 was present in 34 (34%) and cQFR > 0.90 in 39 (39%) vessels. For both QFR models, none of the vessels with QFR > 0.90 had an FFR ≤ 0.80.
Conclusions
QFR appears to be a safe and effective gatekeeper to wire-based FFR when applying a QFR threshold of >0.90 to rule out significant CAD. Further prospective research is required to establish QFR in the real-life setting of functional CAD assessment in the catheterization laboratory.
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Affiliation(s)
- Daan Ties
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Randy van Dijk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Gabija Pundziute
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Erik Lipsic
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Ton E Vonck
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Ad F M van den Heuvel
- University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Matthijs Oudkerk
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands
| | - Pim van der Harst
- University of Groningen, University Medical Center Groningen, Center for Medical Imaging, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Cardiology, Groningen, The Netherlands.
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178
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Asano T, Katagiri Y, Collet C, Tenekecioglu E, Miyazaki Y, Sotomi Y, Amoroso G, Aminian A, Brugaletta S, Vrolix M, Hernandez-Antolín R, van de Harst P, Íñiguez-Romo A, Janssens L, Smits PC, Wykrzykowska JJ, Ribeiro VG, Pereira H, da Silva PC, Piek JJ, Reiber JH, von Birgelen C, Sabaté M, Onuma Y, Serruys PW. Functional comparison between the BuMA Supreme biodegradable polymer sirolimus-eluting stent and a durable polymer zotarolimus-eluting coronary stent using quantitative flow ratio: PIONEER QFR substudy. EUROINTERVENTION 2018; 14:e570-e579. [DOI: 10.4244/eij-d-17-00461] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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179
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Assessment of boundary conditions for CFD simulation in human carotid artery. Biomech Model Mechanobiol 2018; 17:1581-1597. [PMID: 29982960 DOI: 10.1007/s10237-018-1045-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 06/19/2018] [Indexed: 01/19/2023]
Abstract
Computational fluid dynamics (CFD) is an increasingly used method for investigation of hemodynamic parameters and their alterations under pathological conditions, which are important indicators for diagnosis of cardiovascular disease. In hemodynamic simulation models, the employment of appropriate boundary conditions (BCs) determines the computational accuracy of the CFD simulation in comparison with pressure and velocity measurements. In this study, we have first assessed the influence of inlet boundary conditions on hemodynamic CFD simulations. We selected two typical patients suspected of carotid artery disease, with mild stenosis and severe stenosis. Both patients underwent digital subtraction angiography (DSA), magnetic resonance angiography, and the invasive pressure guide wire measured pressure profile. We have performed computational experiments to (1) study the hemodynamic simulation outcomes of distributions of wall shear stress, pressure, pressure gradient and (2) determine the differences in hemodynamic performances caused by inlet BCs derived from DSA and Womersley analytical solution. Our study has found that the difference is related to the severity of the stenosis; the greater the stenosis, the more the difference ensues. Further, in our study, the two typical subjects with invasively measured pressure profile and thirty subjects with ultrasound Doppler velocimeter (UDV) measurement served as the criteria to evaluate the hemodynamic outcomes of wall shear stress, pressure, pressure gradient and velocity due to different outlet BCs based on the Windkessel model, structured-tree model, and fully developed flow model. According to the pressure profiles, the fully developed model appeared to have more fluctuations compared with the other two models. The Windkessel model had more singularities before convergence. The three outlet BCs models also showed good correlation with the UDV measurement, while the Windkessel model appeared to be slightly better ([Formula: see text]). The structured-tree model was seen to have the best performance in terms of available computational cost and accuracy. The results of our numerical simulation and the good correlation with the computed pressure and velocity with their measurements have highlighted the effectiveness of CFD simulation in patient-specific human carotid artery with suspected stenosis.
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180
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Zhong L, Zhang JM, Su B, Tan RS, Allen JC, Kassab GS. Application of Patient-Specific Computational Fluid Dynamics in Coronary and Intra-Cardiac Flow Simulations: Challenges and Opportunities. Front Physiol 2018; 9:742. [PMID: 29997520 PMCID: PMC6028770 DOI: 10.3389/fphys.2018.00742] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/28/2018] [Indexed: 12/13/2022] Open
Abstract
The emergence of new cardiac diagnostics and therapeutics of the heart has given rise to the challenging field of virtual design and testing of technologies in a patient-specific environment. Given the recent advances in medical imaging, computational power and mathematical algorithms, patient-specific cardiac models can be produced from cardiac images faster, and more efficiently than ever before. The emergence of patient-specific computational fluid dynamics (CFD) has paved the way for the new field of computer-aided diagnostics. This article provides a review of CFD methods, challenges and opportunities in coronary and intra-cardiac flow simulations. It includes a review of market products and clinical trials. Key components of patient-specific CFD are covered briefly which include image segmentation, geometry reconstruction, mesh generation, fluid-structure interaction, and solver techniques.
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Affiliation(s)
- Liang Zhong
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Jun-Mei Zhang
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Boyang Su
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore
| | - Ru San Tan
- National Heart Centre Singapore, National Heart Research Institute of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | | | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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181
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Wu X, von Birgelen C, Muramatsu T, Li Y, Holm NR, Reiber JHC, Tu S. A novel four-dimensional angiographic approach to assess dynamic superficial wall stress of coronary arteries in vivo: initial experience in evaluating vessel sites with subsequent plaque rupture. EUROINTERVENTION 2018; 13:e1099-e1103. [PMID: 28262624 DOI: 10.4244/eij-d-16-01020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Repetitive, fluctuating stress is an important biomechanical mechanism that underlies the rupture of atherosclerotic plaques. We developed a novel coronary angiography-based method for in vivo four-dimensional analysis of dynamic superficial wall stress (SWS) in coronary plaques and applied it for the first time in two clinical cases. Our aim was to investigate the potential relationship between dynamic stress concentration at baseline and plaque rupture during acute coronary syndrome (ACS) several months later. METHODS AND RESULTS Three-dimensional angiographic reconstructions of the interrogated arteries were performed at several phases of the cardiac cycle, followed by finite element analysis to obtain the dynamic SWS data. The peak stress at baseline was found at the distal and proximal lesion longitudinal shoulders, being 121.8 kPa and 98.0 kPa, respectively. Intriguingly, in both cases, the sites with the highest SWS concentration at baseline co-registered with the location of plaque rupture during ACS, respectively six and 18 months after the baseline angiographic assessment. CONCLUSIONS A novel angiography-based analysis method for four-dimensional evaluation of dynamic SWS was feasible for investigating plaque biomechanical behaviour in vivo. Initial experience suggests that this technique could be useful in exploring mechanisms of future plaque rupture.
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Affiliation(s)
- Xinlei Wu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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182
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Collet C, Grundeken MJ, Asano T, Onuma Y, Wijns W, Serruys PW. State of the art: coronary angiography. EUROINTERVENTION 2018; 13:634-643. [PMID: 28844026 DOI: 10.4244/eij-d-17-00465] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In the early days of coronary angiography, the precise quantification of luminal narrowing was challenging. The introduction of balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA]) by Andreas Grüntzig in 1977 was perhaps the greatest incentive to the development of quantitative coronary angiography (QCA). QCA has played a crucial role in evaluating interventional techniques and assessing the results of new technologies. With the advent of drug-eluting stents (DES), QCA metrics such as late lumen loss and diameter stenosis (restenosis) proved to be instrumental in assessing new technologies. Refinements in QCA with the advent of dedicated bifurcation analysis and three-dimensional (3D) QCA have broadened the application of QCA. Beyond angiographic metrics, new developments in the field of QCA have introduced the functional component in the assessment of coronary lesions. Angiography-derived fractional flow reserve (FFR) may be a good tool for diagnosing ischaemia-producing lesions in patients with non-complex coronary artery disease. Furthermore, the incremental functional information can be used to expand the traditional late lumen loss (LLL) and restenosis concepts.
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Affiliation(s)
- Carlos Collet
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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183
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Hachamovitch R. Modeling Fractional Flow Reserve: Developing an Estimate of a Better Mousetrap. Circ Cardiovasc Imaging 2018; 11:e007939. [PMID: 29895716 DOI: 10.1161/circimaging.118.007939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rory Hachamovitch
- Cardiovascular Imaging Section, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Ohio
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184
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Superficial wall stress: the long awaited comprehensive biomechanical parameter to objectify and quantify our intuition. Int J Cardiovasc Imaging 2018; 34:863-865. [DOI: 10.1007/s10554-018-1386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
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185
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Pyxaras SA, Wijns W, Reiber JHC, Bax JJ. Invasive assessment of coronary artery disease. J Nucl Cardiol 2018; 25:860-871. [PMID: 28849416 DOI: 10.1007/s12350-017-1050-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 08/08/2017] [Indexed: 01/29/2023]
Abstract
Coronary artery disease is associated to high mortality and morbidity rates and an accurate diagnostic assessment during heart catheterization has a fundamental role in prognostic stratification and treatment choices. Coronary angiography has been integrated by intravascular imaging modalities, namely intravascular ultrasound and optical coherence tomography, which allow the precise quantification of the atherosclerotic burden of coronary arteries. The hemodynamic relevance of a given coronary stenosis can be assessed using stress or resting indexes: fractional flow reserve and instantaneous wave-free ratio are both coronary flow surrogates, used to guide percutaneous coronary interventions. This review summarizes the current state-of-the-art of invasive diagnostic methods during heart catheterization and highlights the potential role that an integration of anatomical and functional information enables.
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Affiliation(s)
- Stylianos A Pyxaras
- Cardiology Department, Coburg-Clinic, Ketschendorfer Str. 33, 96450, Coburg, Germany.
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway and Saolta University Healthcare Group, Galway, Ireland
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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186
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Li Y, Li Z, Holck EN, Xu B, Karanasos A, Fei Z, Chang Y, Chu M, Dijkstra J, Christiansen EH, Reiber JHC, Holm NR, Tu S. Local Flow Patterns After Implantation of Bioresorbable Vascular Scaffold in Coronary Bifurcations - Novel Findings by Computational Fluid Dynamics. Circ J 2018; 82:1575-1583. [PMID: 29576586 DOI: 10.1253/circj.cj-17-1332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Development of methods for accurate reconstruction of bioresorbable scaffolds (BRS) and assessing local hemodynamics is crucial for investigation of vascular healing after BRS implantation.Methods and Results:Patients with BRS that crossed over in a coronary bifurcation were included for analysis. Reconstructions of the coronary lumen and BRS were performed by fusion of optical coherence tomography and coronary angiography generating a tree model (TM) and a hybrid model with BRS (TM-BRS). A virtual BRS model with thinner struts was created and all 3 models were analyzed using computational fluid dynamics to derive: (1) time-average shear stress (TASS), (2) TASS gradient (TASSG), which represents SS heterogeneity, and (3) fractional flow reserve (FFR). Reconstruction of the BRS was successful in all 10 patients. TASS and TASSG were both higher by TM-BRS than by TM in main vessels (difference 0.27±4.30 Pa and 10.18±27.28 Pa/mm, P<0.001), with a remarkable difference at side branch ostia (difference 13.51±17.40 Pa and 81.65±105.19 Pa/mm, P<0.001). With thinner struts, TASS was lower on the strut surface but higher at the inter-strut zones, whereas TASSG was lower in both regions (P<0.001 for all). Computational FFR was lower by TM-BRS than by TM for both main vessels and side branches (P<0.001). CONCLUSIONS Neglecting BRS reconstruction leads to significantly lower SS and SS heterogeneity, which is most pronounced at side branch ostia. Thinner struts can marginally reduce SS heterogeneity.
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Affiliation(s)
- Yingguang Li
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Emil N Holck
- Department of Cardiology, Aarhus University Hospital
| | - Bo Xu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital
| | | | - Zhenyu Fei
- Department of Biomedical Engineering, University of Michigan
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
| | - Jouke Dijkstra
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | | | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University
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187
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Albaghdadi M, Jaffer FA. Wire-Free and Adenosine-Free Fractional Flow Reserve Derived From the Angiogram: A Promising Future Awaiting Outcomes Data. Circ Cardiovasc Imaging 2018; 11:e007594. [PMID: 29555837 DOI: 10.1161/circimaging.118.007594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mazen Albaghdadi
- From the Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Farouc A Jaffer
- From the Cardiovascular Research Center and Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston.
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188
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Westra J, Tu S, Winther S, Nissen L, Vestergaard MB, Andersen BK, Holck EN, Fox Maule C, Johansen JK, Andreasen LN, Simonsen JK, Zhang Y, Kristensen SD, Maeng M, Kaltoft A, Terkelsen CJ, Krusell LR, Jakobsen L, Reiber JHC, Lassen JF, Bøttcher M, Bøtker HE, Christiansen EH, Holm NR. Evaluation of Coronary Artery Stenosis by Quantitative Flow Ratio During Invasive Coronary Angiography: The WIFI II Study (Wire-Free Functional Imaging II). Circ Cardiovasc Imaging 2018; 11:e007107. [PMID: 29555835 PMCID: PMC5895131 DOI: 10.1161/circimaging.117.007107] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/11/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel diagnostic modality for functional testing of coronary artery stenosis without the use of pressure wires and induction of hyperemia. QFR is based on computation of standard invasive coronary angiographic imaging. The purpose of WIFI II (Wire-Free Functional Imaging II) was to evaluate the feasibility and diagnostic performance of QFR in unselected consecutive patients. METHODS AND RESULTS WIFI II was a predefined substudy to the Dan-NICAD study (Danish Study of Non-Invasive Diagnostic Testing in Coronary Artery Disease), referring 362 consecutive patients with suspected coronary artery disease on coronary computed tomographic angiography for diagnostic invasive coronary angiography. Fractional flow reserve (FFR) was measured in all segments with 30% to 90% diameter stenosis. Blinded observers calculated QFR (Medis Medical Imaging bv, The Netherlands) for comparison with FFR. FFR was measured in 292 lesions from 191 patients. Ten (5%) and 9 patients (5%) were excluded because of FFR and angiographic core laboratory criteria, respectively. QFR was successfully computed in 240 out of 255 lesions (94%) with a mean diameter stenosis of 50±12%. Mean difference between FFR and QFR was 0.01±0.08. QFR correctly classified 83% of the lesions using FFR with cutoff at 0.80 as reference standard. The area under the receiver operating characteristic curve was 0.86 (95% confidence interval, 0.81-0.91) with a sensitivity, specificity, negative predictive value, and positive predictive value of 77%, 86%, 75%, and 87%, respectively. A QFR-FFR hybrid approach based on the present results enables wire-free and adenosine-free procedures in 68% of cases. CONCLUSIONS Functional lesion evaluation by QFR assessment showed good agreement and diagnostic accuracy compared with FFR. Studies comparing clinical outcome after QFR- and FFR-based diagnostic strategies are required. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02264717.
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Affiliation(s)
- Jelmer Westra
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.).
| | - Shengxian Tu
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.).
| | - Simon Winther
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Louise Nissen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Mai-Britt Vestergaard
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Birgitte Krogsgaard Andersen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Emil Nielsen Holck
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Camilla Fox Maule
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Jane Kirk Johansen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Lene Nyhus Andreasen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Jo Krogsgaard Simonsen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Yimin Zhang
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Steen Dalby Kristensen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Michael Maeng
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Anne Kaltoft
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Christian Juhl Terkelsen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Lars Romer Krusell
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Lars Jakobsen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Johan H C Reiber
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Jens Flensted Lassen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Morten Bøttcher
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Hans Erik Bøtker
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Evald Høj Christiansen
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
| | - Niels Ramsing Holm
- From the Department of Cardiology, Aarhus University Hospital, Skejby, Denmark (J.W., S.W., M.-B.V., B.K.A., E.N.H., C.F.M., L.N.A., J.K.S., S.D.K., M.M., A.K., C.J.T., L.R.K., L.J., J.F.L., H.E.B., E.H.C., N.R.H.); Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (S.T., Y.Z.); Department of Cardiology, Hospitalsenheden Vest, Regionshospitalet Herning, Denmark (L.N., M.B.); Department of Cardiology, Hospitalsenheden Midt, Regionshospitalet Silkeborg, Denmark (J.K.J.); and Department of Radiology, Leiden University Medical Center, The Netherlands (J.H.C.R.)
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Chu M, von Birgelen C, Li Y, Westra J, Yang J, Holm NR, Reiber JHC, Wijns W, Tu S. Quantification of disturbed coronary flow by disturbed vorticity index and relation with fractional flow reserve. Atherosclerosis 2018; 273:136-144. [PMID: 29501225 DOI: 10.1016/j.atherosclerosis.2018.02.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/27/2018] [Accepted: 02/14/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The relation between FFR and local coronary flow patterns is incompletely understood. We aimed at developing a novel hemodynamic index to quantify disturbed coronary flow, and to investigate its relationship with lesion-associated pressure-drop, and fractional flow reserve (FFR). METHODS Three-dimensional angiographic reconstruction and computational fluid dynamics were applied to simulate pulsatile coronary flow. Disturbed vorticity index (DVI) was derived to quantify the stenosis-induced flow disturbance. The relation between DVI and pressure-drop was assessed in 9 virtual obstruction models. Furthermore, we evaluated the correlation between DVI, FFR, hyperemic flow velocity, and anatomic parameters in 84 intermediate lesions from 73 patients. RESULTS In virtual models, DVI increased with increasing flow rate, stenosis severity, and lesion complexity. The correlation between DVI and pressure-drop across all models was excellent (determination coefficient R2 = 0.85, p < 0.001). In vivo, DVI showed a correlation with FFR (rho (ρ) = -0.74, p < 0.001) that was stronger than the relations of FFR with hyperemic flow velocity (ρ = -0.27, p=0.015), lesion length (ρ = -0.36, p=0.001) and percent diameter stenosis (ρ = -0.40, p < 0.001). CONCLUSIONS DVI, a novel index to quantify disturbed flow, was related to pressure-drop in virtual obstruction models and showed a strong inverse relation with FFR in intermediate lesions in vivo. It supports the prognostic value of FFR and may provide additional information about sources of energy loss when measuring FFR.
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Affiliation(s)
- Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China
| | | | - Yingguang Li
- Division of Image Processing, Leiden University Medical Center, The Netherlands
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Junqing Yang
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Johan H C Reiber
- Division of Image Processing, Leiden University Medical Center, The Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China; Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, China.
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190
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Wu X, von Birgelen C, Li Z, Zhang S, Huang J, Liang F, Li Y, Wijns W, Tu S. Assessment of superficial coronary vessel wall deformation and stress: validation of in silico models and human coronary arteries in vivo. Int J Cardiovasc Imaging 2018; 34:849-861. [PMID: 29397475 DOI: 10.1007/s10554-018-1311-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Abstract
Cyclic biomechanical stress at the lumen-intima interface plays a crucial role in the rupture of coronary plaque. We performed a comprehensive assessment of a novel angiography-based method for four-dimensional (4D) dynamic assessment of superficial wall stress (SWS) and deformation with a total of 32 analyses in virtual stenosis models with equal lumen dimensions and 16 analyses in human coronary arteries in vivo. The in silico model analyses demonstrated that the SWS, derived by the proposed global displacement method without knowledge of plaque components or blood pressure, was comparable with the result calculated by traditional finite element method. Cardiac contraction-induced vessel deformation increased SWS. Softer plaque and positive arterial remodeling, associated with a greater plaque burden, showed more variation in mean lumen diameter within the cardiac cycle and resulted in higher SWS. In vivo patient analyses confirmed the accuracy of computed superficial wall deformation. The centerlines predicted by our method at random selected time instant matched well with the actual one in angiograms by Procrustes analysis (scaling: 0.995 ± 0.018; dissimilarity: 0.007 ± 0.014). Over 50% of the maximum SWS occurred at proximal plaque shoulders. This novel 4D approach could be successfully to predict superficial wall deformation of coronary artery in vivo. The dynamic SWS might be more realistic to evaluate the risk of plaque rupture.
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Affiliation(s)
- Xinlei Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiayue Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yingguang Li
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland.,Saolta University Healthcare Group, Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China. .,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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191
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Chen H, Li Y, Reiber JH, de Lange J, Tu S, van der Stelt P, Lobbezoo F, Aarab G. Analyses of aerodynamic characteristics of the oropharynx applying CBCT: obstructive sleep apnea patients versus control subjects. Dentomaxillofac Radiol 2018; 47:20170238. [PMID: 29076751 DOI: 10.1259/dmfr.20170238] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the most relevant aerodynamic characteristic of the oropharynx related to the collapse of the upper airway in obstructive sleep apnea (OSA) patients; and to determine the correlation between the most relevant aerodynamic characteristic(s) of the oropharynx and anatomical characteristics of the oropharynx in OSA patients. METHODS 31 mild to moderate OSA patients (mean ± SD age = 43.5 ± 9.7 years) and 13 control subjects (mean ± SD age = 48.5 ± 16.2 years) were included in this prospective study. The diagnosis of OSA patients was based on an overnight polysomnographic recording. To exclude the presence of OSA in the control subjects, they were asked to fill out a validated questionnaire to determine the risk of OSA. NewTom5G cone beam CT (CBCT) scans were obtained from both OSA patients and control subjects. Computational models of the oropharynx were reconstructed based on CBCT images. The aerodynamic characteristics of the oropharynx were calculated based on these computational models. Pearson correlation analysis was used to analyse the correlation between the most relevant aerodynamic characteristic(s) and anatomical characteristics of the oropharynx in OSA patients. RESULTS Compared with controls, the airway resistance during expiration (Rex) of the OSA patients was significantly higher (p = 0.04). There was a significant negative correlation between Rex and the minimum cross-sectional area (CSAmin) of the oropharynx (r = -0.41, p = 0.02), and between Rex and the volume of the oropharynx (r = -0.48, p = 0.01) in OSA patients. After excluding an outlier, there is only significant correlation between Rex and the CSAmin of the oropharynx (r = -0.45, p = 0.01). CONCLUSIONS Within the limitations of this study, we concluded that the most relevant aerodynamic characteristic of the oropharynx in the collapse of the upper airway in OSA patients is Rex. Therefore, the repetitive collapse of the upper airway in OSA patients may be explained by a high Rex, which is related to the CSAmin of the oropharynx.
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Affiliation(s)
- Hui Chen
- 1 Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands.,2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Yingguang Li
- 3 Division of Image Processing, Department of Radiology, Leiden University Medical Centre , Leiden University Medical Centre , Leiden , The Netherlands
| | - Johan Hc Reiber
- 3 Division of Image Processing, Department of Radiology, Leiden University Medical Centre , Leiden University Medical Centre , Leiden , The Netherlands
| | - Jan de Lange
- 4 Department of Oral and Maxillofacial Surgery, Academic Centre for Dentistry Amsterdam (ACTA) and Academic Medical Centre (AMC), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA) and Academic Medical Centre (AMC), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Shengxian Tu
- 5 Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University , Shanghai , China
| | - Paul van der Stelt
- 1 Department of Oral Radiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Frank Lobbezoo
- 2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
| | - Ghizlane Aarab
- 2 Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam , Amsterdam , The Netherlands
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Lassen J, Burzotta F, Banning A, Lefèvre T, Darremont O, Hildick-Smith D, Chieffo A, Pan M, Holm N, Louvard Y, Stankovic G. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EUROINTERVENTION 2018; 13:1540-1553. [DOI: 10.4244/eij-d-17-00622] [Citation(s) in RCA: 152] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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193
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Gosling RC, Morris PD, Lawford PV, Hose DR, Gunn JP. Predictive Physiological Modeling of Percutaneous Coronary Intervention - Is Virtual Treatment Planning the Future? Front Physiol 2018; 9:1107. [PMID: 30154734 PMCID: PMC6103238 DOI: 10.3389/fphys.2018.01107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/23/2018] [Indexed: 01/10/2023] Open
Abstract
Computational modeling has been used routinely in the pre-clinical development of medical devices such as coronary artery stents. The ability to simulate and predict physiological and structural parameters such as flow disturbance, wall shear-stress, and mechanical strain patterns is beneficial to stent manufacturers. These methods are now emerging as useful clinical tools, used by physicians in the assessment and management of patients. Computational models, which can predict the physiological response to intervention, offer clinicians the ability to evaluate a number of different treatment strategies in silico prior to treating the patient in the cardiac catheter laboratory. For the first time clinicians can perform a patient-specific assessment prior to making treatment decisions. This could be advantageous in patients with complex disease patterns where the optimal treatment strategy is not clear. This article reviews the key advances and the potential barriers to clinical adoption and translation of these virtual treatment planning models.
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Affiliation(s)
- Rebecca C. Gosling
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
- *Correspondence: Rebecca C. Gosling,
| | - Paul D. Morris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
- These authors have contributed equally to this work and are joint first authors
| | - Patricia V. Lawford
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
| | - D. Rodney Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julian P. Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
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Boileau E, Pant S, Roobottom C, Sazonov I, Deng J, Xie X, Nithiarasu P. Estimating the accuracy of a reduced-order model for the calculation of fractional flow reserve (FFR). INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34. [PMID: 28600860 DOI: 10.1002/cnm.2908] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Image-based noninvasive fractional flow reserve (FFR) is an emergent approach to determine the functional relevance of coronary stenoses. The present work aimed to determine the feasibility of using a method based on coronary computed tomography angiography (CCTA) and reduced-order models (0D-1D) for the evaluation of coronary stenoses. The reduced-order methodology (cFFRRO ) was kept as simple as possible and did not include pressure drop or stenosis models. The geometry definition was incorporated into the physical model used to solve coronary flow and pressure. cFFRRO was assessed on a virtual cohort of 30 coronary artery stenoses in 25 vessels and compared with a standard approach based on 3D computational fluid dynamics (cFFR3D ). In this proof-of-concept study, we sought to investigate the influence of geometry and boundary conditions on the agreement between both methods. Performance on a per-vessel level showed a good correlation between both methods (Pearson's product-moment R=0.885, P<0.01), when using cFFR3D as the reference standard. The 95% limits of agreement were -0.116 and 0.08, and the mean bias was -0.018 (SD =0.05). Our results suggest no appreciable difference between cFFRRO and cFFR3D with respect to lesion length and/or aspect ratio. At a fixed aspect ratio, however, stenosis severity and shape appeared to be the most critical factors accounting for differences in both methods. Despite the assumptions inherent to the 1D formulation, asymmetry did not seem to affect the agreement. The choice of boundary conditions is critical in obtaining a functionally significant drop in pressure. Our initial data suggest that this approach may be part of a broader risk assessment strategy aimed at increasing the diagnostic yield of cardiac catheterisation for in-hospital evaluation of haemodynamically significant stenoses.
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Affiliation(s)
- Etienne Boileau
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| | - Sanjay Pant
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| | - Carl Roobottom
- Derriford Hospital and Peninsula Medical School, Plymouth Hospitals NHS Trust, Derriford Rd, Crownhill, Plymouth, PL6 8DH,, UK
| | - Igor Sazonov
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| | - Jingjing Deng
- Department of Computer Science, Swansea University, Swansea, SA2 8PP, UK
| | - Xianghua Xie
- Department of Computer Science, Swansea University, Swansea, SA2 8PP, UK
| | - Perumal Nithiarasu
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
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Papafaklis MI, Mavrogiannis MC, Siogkas PK, Lakkas LS, Katsouras CS, Fotiadis DI, Michalis LK. Functional assessment of lesion severity without using the pressure wire: coronary imaging and blood flow simulation. Expert Rev Cardiovasc Ther 2017; 15:863-877. [PMID: 28902523 DOI: 10.1080/14779072.2017.1379899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michail I. Papafaklis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
- Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Panagiotis K. Siogkas
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Lampros S. Lakkas
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Dimitrios I. Fotiadis
- Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
| | - Lampros K. Michalis
- Second Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
- Michailideion Cardiac Center, Medical School, University of Ioannina, Ioannina, Greece
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196
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Xu B, Tu S, Qiao S, Qu X, Chen Y, Yang J, Guo L, Sun Z, Li Z, Tian F, Fang W, Chen J, Li W, Guan C, Holm NR, Wijns W, Hu S. Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis. J Am Coll Cardiol 2017; 70:3077-3087. [PMID: 29101020 DOI: 10.1016/j.jacc.2017.10.035] [Citation(s) in RCA: 325] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quantitative flow ratio (QFR) is a novel angiography-based method for deriving fractional flow reserve (FFR) without pressure wire or induction of hyperemia. The accuracy of QFR when assessed online in the catheterization laboratory has not been adequately examined to date. OBJECTIVES The goal of this study was to assess the diagnostic performance of QFR for the diagnosis of hemodynamically significant coronary stenosis defined by FFR ≤0.80. METHODS This prospective, multicenter trial enrolled patients who had at least 1 lesion with a diameter stenosis of 30% to 90% and a reference diameter ≥2 mm according to visual estimation. QFR, quantitative coronary angiography (QCA), and wire-based FFR were assessed online in blinded fashion during coronary angiography and re-analyzed offline at an independent core laboratory. The primary endpoint was that QFR would improve the diagnostic accuracy of coronary angiography such that the lower boundary of the 2-sided 95% confidence interval (CI) of this estimate exceeded 75%. RESULTS Between June and July 2017, a total of 308 patients were consecutively enrolled at 5 centers. Online QFR and FFR results were both obtained in 328 of 332 interrogated vessels. Patient- and vessel-level diagnostic accuracy of QFR was 92.4% (95% CI: 88.9% to 95.1%) and 92.7% (95% CI: 89.3% to 95.3%), respectively, both of which were significantly higher than the pre-specified target value (p < 0.001). Sensitivity and specificity in identifying hemodynamically significant stenosis were significantly higher for QFR than for QCA (sensitivity: 94.6% vs. 62.5%; difference: 32.0% [p < 0.001]; specificity: 91.7% vs. 58.1%; difference: 36.1% [p < 0.001]). Positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for QFR were 85.5%, 97.1%, 11.4, and 0.06. Offline analysis also revealed that vessel-level QFR had a high diagnostic accuracy of 93.3% (95% CI: 90.0% to 95.7%). CONCLUSIONS The study met its prespecified primary performance goal for the level of diagnostic accuracy of QFR in identifying hemodynamically significant coronary stenosis. (The FAVOR [Functional Diagnostic Accuracy of Quantitative Flow Ratio in Online Assessment of Coronary Stenosis] II China study]; NCT03191708).
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Affiliation(s)
- Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Shubin Qiao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xinkai Qu
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yundai Chen
- Chinese PLA General Hospital, Beijing, China
| | | | - Lijun Guo
- Peking University Third Hospital, Beijing, China
| | - Zhongwei Sun
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Zehang Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Tian
- Chinese PLA General Hospital, Beijing, China
| | - Weiyi Fang
- Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiyan Chen
- Guangdong General Hospital, Guangzhou, China
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Changdong Guan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | | | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland
| | - Shengshou Hu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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197
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Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, Nef H, Tebaldi M, Murasato Y, Lansky A, Barbato E, van der Heijden LC, Reiber JHC, Holm NR, Wijns W. Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv 2017; 9:2024-2035. [PMID: 27712739 DOI: 10.1016/j.jcin.2016.07.013] [Citation(s) in RCA: 376] [Impact Index Per Article: 53.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this prospective multicenter study was to identify the optimal approach for simple and fast fractional flow reserve (FFR) computation from radiographic coronary angiography, called quantitative flow ratio (QFR). BACKGROUND A novel, rapid computation of QFR pullbacks from 3-dimensional quantitative coronary angiography was developed recently. METHODS QFR was derived from 3 flow models with: 1) fixed empiric hyperemic flow velocity (fixed-flow QFR [fQFR]); 2) modeled hyperemic flow velocity derived from angiography without drug-induced hyperemia (contrast-flow QFR [cQFR]); and 3) measured hyperemic flow velocity derived from angiography during adenosine-induced hyperemia (adenosine-flow QFR [aQFR]). Pressure wire-derived FFR, measured during maximal hyperemia, served as the reference. Separate independent core laboratories analyzed angiographic images and pressure tracings from 8 centers in 7 countries. RESULTS The QFR and FFR from 84 vessels in 73 patients with intermediate coronary lesions were compared. Mean angiographic percent diameter stenosis (DS%) was 46.1 ± 8.9%; 27 vessels (32%) had FFR ≤ 0.80. Good agreement with FFR was observed for fQFR, cQFR, and aQFR, with mean differences of 0.003 ± 0.068 (p = 0.66), 0.001 ± 0.059 (p = 0.90), and -0.001 ± 0.065 (p = 0.90), respectively. The overall diagnostic accuracy for identifying an FFR of ≤0.80 was 80% (95% confidence interval [CI]: 71% to 89%), 86% (95% CI: 78% to 93%), and 87% (95% CI: 80% to 94%). The area under the receiver-operating characteristic curve was higher for cQFR than fQFR (difference: 0.04; 95% CI: 0.01 to 0.08; p < 0.01), but did not differ significantly between cQFR and aQFR (difference: 0.01; 95% CI: -0.04 to 0.06; p = 0.65). Compared with DS%, both cQFR and aQFR increased the area under the receiver-operating characteristic curve by 0.20 (p < 0.01) and 0.19 (p < 0.01). The positive likelihood ratio was 4.8, 8.4, and 8.9 for fQFR, cQFR, and aQFR, with negative likelihood ratio of 0.4, 0.3, and 0.2, respectively. CONCLUSIONS The QFR computation improved the diagnostic accuracy of 3-dimensional quantitative coronary angiography-based identification of stenosis significance. The favorable results of cQFR that does not require pharmacologic hyperemia induction bears the potential of a wider adoption of FFR-based lesion assessment through a reduction in procedure time, risk, and costs.
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Affiliation(s)
- Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Junqing Yang
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, and Health Technology and Services Research, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Angela Ferrara
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium
| | - Mariano Pellicano
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Holger Nef
- Department of Cardiology and Angiology, University of Giessen, Giessen, Germany
| | - Matteo Tebaldi
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Yoshinobu Murasato
- Department of Cardiology, Clinical Research Center, Kyushu Medical Center, Fukuoka, Japan
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Emanuele Barbato
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples, Federico II, Naples, Italy
| | - Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, and Health Technology and Services Research, MIRA Institute, University of Twente, Enschede, the Netherlands
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - William Wijns
- Cardiovascular Research Centre, OLV Hospital, Aalst, Belgium; The Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, and Saolta University Healthcare Group, Galway, Ireland
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198
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Morris PD, Gunn JP. Computing Fractional Flow Reserve From Invasive Coronary Angiography. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005806. [DOI: 10.1161/circinterventions.117.005806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Paul D. Morris
- From the Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, and Insigneo Institute for In Silico Medicine, University of Sheffield, United Kingdom (P.D.M., J.P.G.); and Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (P.D.M., J.P.G.)
| | - Julian P. Gunn
- From the Mathematical Modelling in Medicine Group, Department of Infection, Immunity and Cardiovascular Disease, and Insigneo Institute for In Silico Medicine, University of Sheffield, United Kingdom (P.D.M., J.P.G.); and Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom (P.D.M., J.P.G.)
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199
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Case Report of First Angiography-Based On-Line FFR Assessment during Coronary Catheterization. Case Rep Cardiol 2017; 2017:6107327. [PMID: 28835858 PMCID: PMC5556601 DOI: 10.1155/2017/6107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Fractional flow reserve (FFR), an index of the hemodynamic severity of coronary stenoses, is derived from hyperemic pressure measurements and requires a pressure-monitoring guide wire and hyperemic stimulus. Although it has become the standard of reference for decision-making regarding coronary revascularization, the procedure remains underutilized due to its invasive nature. FFRangio is a novel technology that uses the patient's hemodynamic data and routine angiograms to generate a complete three-dimensional coronary tree, with color-coded display of the FFR values at each point along the vessels. After being proven to be as accurate as invasive FFR measurements in an off-line study, this case report presents the first on-line application of the system in the catheterization lab. Here too, a high concordance between FFRangio and invasive FFR was observed. In light of the demonstrated capabilities of the FFRangio system, it should emerge as an important tool for clinical decision-making regarding revascularization in patients with coronary artery disease.
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200
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Morris PD, Silva Soto DA, Feher JF, Rafiroiu D, Lungu A, Varma S, Lawford PV, Hose DR, Gunn JP. Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis: Results From the VIRTU-Fast Study. JACC Basic Transl Sci 2017; 2:434-446. [PMID: 28920099 PMCID: PMC5582193 DOI: 10.1016/j.jacbts.2017.04.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 04/02/2017] [Accepted: 04/04/2017] [Indexed: 11/28/2022]
Abstract
Fractional flow reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel "pseudotransient" analysis protocol for computing virtual fractional flow reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33%) and more by microvascular physiology (59%). If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.
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Key Words
- CAD, coronary artery disease
- CAG, coronary angiography
- CFD, computational fluid dynamics
- CMV, coronary microvasculature
- FFR, fractional flow reserve
- PCI, percutaneous coronary intervention
- RoCA, rotational coronary angiography
- computational fluid dynamics
- coronary artery disease
- coronary microvascular physiology
- coronary modelling
- coronary physiology
- fractional flow reserve
- mFFR, invasively measured fractional flow reserve
- vFFR, virtual fractional flow reserve
- vFFRps-trns, virtual fractional flow reserve computed with the pseudotransient steady-state method
- vFFRsteady, virtual fractional flow reserve computed with steady-state CFD analysis and cycle mean values
- vFFRtrns, virtual fractional flow reserve computed with full transient CFD
- virtual fractional flow reserve
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Affiliation(s)
- Paul D. Morris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Daniel Alejandro Silva Soto
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Jeroen F.A. Feher
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
| | - Dan Rafiroiu
- Department of Electrotechnics and Electrical Measurements, Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | - Angela Lungu
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Susheel Varma
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Patricia V. Lawford
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - D. Rodney Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Julian P. Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, United Kingdom
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