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Yuta F, Kawamori H, Toba T, Hiromasa T, Sasaki S, Hamana T, Fujii H, Osumi Y, Iwane S, Yamamoto T, Naniwa S, Sakamoto Y, Matsuhama K, Hirata KI, Otake H. Diagnostic accuracy of Murray law-based quantitative flow ratio in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Heart Vessels 2024; 39:735-745. [PMID: 38526753 DOI: 10.1007/s00380-024-02387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/28/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Murray law-based quantitative flow ratio (μQFR) is a novel computational method that enables accurate estimation of fractional flow reserve (FFR) using a single angiographic projection. However, its diagnostic value in patients with severe aortic stenosis (AS) remains unclear. METHOD We included 25 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS with intermediate or greater (30-90%) coronary artery disease (CAD). Pre- and post-TAVR μQFR, QFR, instantaneous flow reserve (iFR), and post-TAVR invasive FFR values were measured. We evaluated the diagnostic performance of pre-TAVR μQFR, QFR, and iFR using post-TAVR FFR ≤ 0.80 as a reference standard of ischemia. RESULT Pre-TAVR μQFR was significantly correlated with post-TAVR FFR (r = 0.73, p < 0.0001). The area under the curve of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 was 0.91 (95% confidence interval [CI] 0.77-0.98), comparable to that of pre-TAVR iFR (0.86 [95% CI 0.71-0.98], p = 0.97). The accuracy, sensitivity, specificity, and positive and negative predictive values of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 were 84.2% (95% CI 68.7-93.4), 61.6% (95% CI 31.6-86.1), 96.0% (95% CI 79.6-99.9), 88.9% (95% CI 52.9-98.3), and 82.8% (95% CI 70.6-90.6), respectively. For pre-TAVR iFR, these values were 76.5% (95% CI 58.8-89.3), 90.9% (95% CI 58.7-99.8), 69.6% (95% CI 47.1-86.8), 58.8% (95% CI 42.8-73.1), and 94.1% (95% CI 70.8-99.1), respectively. CONCLUSION μQFR could be useful for the physiological evaluation of patients with severe AS with concomitant CAD.
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Affiliation(s)
- Fukuishi Yuta
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takashi Hiromasa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Satoru Sasaki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuto Osumi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Seigo Iwane
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Tetsuya Yamamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shota Naniwa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Koshi Matsuhama
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
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Huang K, Yao W, Song Z, Jia X, Gao J, Liu R, Han Y, Liu X, Du J, Tu S, Zhu W. Prognostic value of angiographic based quantitative flow ratio and anatomic features in intracranial atherosclerotic stenosis. J Neurointerv Surg 2024:jnis-2024-022007. [PMID: 39060109 DOI: 10.1136/jnis-2024-022007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Patients with intracranial atherosclerotic stenosis (ICAS) are prone to stroke recurrence despite aggressive medical treatment. Further assessment of the anatomy and physiology of ICAS is urgently needed to facilitate individualized therapy. We explored the predictive value of angiography based hemodynamic and anatomical features for ICAS patients. METHODS In this retrospective study, patients with moderate-to-severe stenosis of the middle cerebral artery (MCA) were enrolled. The hemodynamic assessment was performed using the single view Murray's law based quantitative flow ratio (μQFR) approach. The locations of lesions were categorized as perforator rich segments of the MCA (pMCA) and others. Multivariate Cox models were developed to identify significant predictors. The primary outcomes were defined as stroke and transient ischemic attack. RESULTS Among the 333 patients (median (IQR) age, 56 (49-63) years, 70.3% men) over a median follow-up period of 64.5 months, 50 (15.0%) had the primary outcomes, and 80.0% occurred within 5 years. Patients with lower μQFR values (dichotomized at 0.73) had a higher risk of the 5 year primary outcomes (log rank P=0.023), and good collateral circulation may have attenuated the risk. In the multivariate analyses, μQFR (adjusted HR=0.345; 95% CI 0.155 to 0.766; P=0.009), lesion located in pMCA (adjusted HR=0.377; 95% CI 0.190 to 0.749; P=0.005), and diameter ratio of the internal carotid artery (adjusted HR=4.187; 95% CI 1.071 to 16.370; P=0.040) were significantly associated with the 5 year primary outcomes. CONCLUSIONS Angiography based μQFR and anatomical features, namely plaque localization and internal carotid artery expansion, could serve as promising prognostic indexes for MCA atherosclerosis.
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Affiliation(s)
- Kangmo Huang
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weihe Yao
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Zhiruo Song
- Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Xuerong Jia
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Jie Gao
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Juan Du
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wusheng Zhu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Qian G, Qin H, Deng D, Feng Y, Zhang C, Qu X, Zhang Z. Prognostic value of angiographic microvascular resistance in patients with ST-segment elevation myocardial infarction. Clinics (Sao Paulo) 2024; 79:100429. [PMID: 39053030 PMCID: PMC11327545 DOI: 10.1016/j.clinsp.2024.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/24/2024] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The Angiographic Microvascular Resistance (AMR), derived from a solitary angiographic view, has emerged as a viable substitute for the Index of Microcirculatory Resistance (IMR). However, the prognostic significance in ST-Segment Elevation Myocardial Infarction (STEMI) patients is yet to be established. This research endeavors to explore the prognostic capabilities of AMR in patients diagnosed with STEMI. METHODS In this single-center, retrospective study, 232 patients diagnosed with STEMI who received primary Percutaneous Coronary Intervention (PCI) were recruited from January 1, 2018, to June 30, 2022. Utilizing the maximally selected log-rank statistics analysis, participants were divided into two cohorts according to an AMR threshold of 2.55 mmHg*s/cm. The endpoint evaluated was a composite of all-cause mortality or hospital readmission due to heart failure. RESULTS At a median follow-up of 1.74 (1.07, 3.65) years, the composite endpoint event was observed in 28 patients within the higher AMR group and 8 patients within the lower AMR group. The higher AMR group showed a significantly higher risk for composite outcome compared to those within the low-AMR group (HRadj: 3.33; 95% CI 1.30‒8.52; p = 0.03). AMR ≥ 2.55 mmHg*s/cm was an independent predictor of the composite endpoint (HR = 2.33; 95% CI 1.04‒5.21; p = 0.04). Furthermore, a nomogram containing age, sex, left ventricle ejection fraction, post-PCI Quantitative Flow Ratio (QFR), and AMR was developed and indicated a poorer prognosis in the high-risk group for STEMI patients at 3 years. (HR=4.60; 95% CI 1.91‒11.07; p < 0.01). CONCLUSIONS AMR measured after PCI can predict the risk of all-cause death or readmission for heart failure in patients with STEMI. AMR-involved nomograms improved predictive performance over variables alone.
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Affiliation(s)
- Gangzhen Qian
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China
| | - Haoran Qin
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China
| | - Dan Deng
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yue Feng
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China
| | - Chao Zhang
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xiaolong Qu
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhihui Zhang
- Department of Cardiovascular Medicine, Center for Circadian Metabolism and Cardiovascular Disease, Southwest Hospital, Army Medical University, Chongqing, China.
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Huang K, Li H, Tu S, Du J, Yao W, Liu R, Han Y, Ye R, Suo S, Zhu W, Liu X. Angiography‑based quantitative flow ratio for functional assessment of intracranial atherosclerotic disease. EUROINTERVENTION 2024; 20:e312-e321. [PMID: 38436369 PMCID: PMC10905197 DOI: 10.4244/eij-d-23-00611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Intracranial atherosclerotic stenosis (ICAS), an important cause of stroke, is associated with a considerable stroke recurrence rate despite optimal medical treatment. Further assessment of the functional significance of ICAS is urgently needed to enable individualised treatment and, thus, improve patient outcomes. AIMS We aimed to evaluate the haemodynamic significance of ICAS using the quantitative flow ratio (QFR) technique and to develop a risk stratification model for ICAS patients. METHODS Patients with moderate to severe stenosis of the middle cerebral artery, as shown on angiography, were retrospectively enrolled. For haemodynamic assessment, the Murray law-based QFR (μQFR) was performed on eligible patients. Multivariate logistic regression models composed of μQFR and other risk factors were developed and compared for the identification of symptomatic lesions. Based on the superior model, a nomogram was established and validated by calibration. RESULTS Among 412 eligible patients, symptomatic lesions were found in 313 (76.0%) patients. The μQFR outperformed the degree of stenosis in discriminating culprit lesions (area under the curve [AUC]: 0.726 vs 0.631; DeLong test p-value=0.001), and the model incorporating μQFR and conventional risk factors also performed better than that containing conventional risk factors only (AUC: 0.850 vs 0.827; DeLong test p-value=0.034; continuous net reclassification index=0.620, integrated discrimination improvement=0.057; both p<0.001). The final nomogram showed good calibration (p for Hosmer-Lemeshow test=0.102) and discrimination (C-statistic 0.850, 95% confidence interval: 0.812-0.883). CONCLUSIONS The μQFR was significantly associated with symptomatic ICAS and outperformed the angiographic stenosis severity. The final nomogram effectively discriminated symptomatic lesions and may provide a useful tool for risk stratification in ICAS patients.
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Affiliation(s)
- Kangmo Huang
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Haotao Li
- Department of Neurology, Changshu No.2 People's Hospital, Changshu, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Juan Du
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Weihe Yao
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shiteng Suo
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Department of Radiology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wusheng Zhu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Nanjing Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Qiu Z, Wang Y, Liu Y, Zhou Z, Wang Z. Diagnostic value of angiography-derived index of microcirculatory resistance (AMR) for coronary microcirculatory dysfunction (CMD) and its prognostic significance in patients with chronic coronary syndromes in the smoking population. Medicine (Baltimore) 2024; 103:e37022. [PMID: 38335436 PMCID: PMC10860928 DOI: 10.1097/md.0000000000037022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/24/2023] [Accepted: 01/02/2024] [Indexed: 02/12/2024] Open
Abstract
This study aims to analyze the prognostic significance of angiographic microvascular resistance (AMR) derived from functional coronary angiography in diagnosing coronary microvascular dysfunction (CMD) among patients with chronic coronary syndrome (CCS), particularly focusing on the prognostic significance of CMD in smokers. Additionally, this study assesses the prognostic significance of the diagnostic accuracy of the AMR index for CMD in CCS patients within the smoking population. Seventy-five CCS patients were studied for IMR measurement between June 2018 and December 2020, classified into CMD and non-CMD groups. Pearson correlation analyzed AMR and IMR relationship, while ROC curves determined AMR's predictive value for CMD with optimal cutoff value. An additional 223 CCS patients were included for AMR measurements. The study's primary endpoint was MACE occurrence, followed up through telephone calls. COX one-way analysis and Kaplan-Meier analysis evaluated the association between AMR and MACE risk. In the study, 52% of patients were diagnosed with CMD, and the AUC under the AMR curve for predicted IMR ≥ 25 was 0.90 (95% CI: 0.79-0.95). The CMD group had a higher proportion of female patients, smokers, and those with hypertension and diabetes mellitus compared to the non-CMD group (all P < .05). The CMD group exhibited higher AMR values than the non-CMD group (3.20 ± 0.5 vs 1.95 ± 0.45, P < .01), with a significant correlation between AMR and IMR (R2 = 0.81, P < .001). The ROC curve illustrated AMR's effectiveness in diagnosing CMD in CCS patients, using IMR as the gold standard, with the optimal cutoff value of AMR = 2.6mmHgs/cm (sensitivity: 90.5%, specificity: 81.5%). Patients with AMR ≥ 2.6mmHgs/cm had a higher risk of MACE events (HR = 6.00; 95% CI: 1.59-22.67). AMR in patients with CCS was significantly correlated with IMR and demonstrated good diagnostic accuracy. AMR ≥ 2.6 mm Hg*s/cm was associated with an increased risk of MACE occurrence and served as a valuable prognostic factor. In patients with CCS, AMR has a high diagnostic performance, In patients with CCS who smoke, impaired coronary microvascular function as assessed by AMR is significant and is an independent predictor of MACE.
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Affiliation(s)
- Zhongjue Qiu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yong Wang
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
- Center for Post-Doctoral Studies, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Yang Liu
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhou Zhou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Zhen Wang
- Department of Cardiology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
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Yamamoto T, Kawamori H, Toba T, Sasaki S, Fujii H, Hamana T, Osumi Y, Iwane S, Naniwa S, Sakamoto Y, Matsuhama K, Fukuishi Y, Hirata K, Otake H. Impact of Pericoronary Adipose Tissue Attenuation on Periprocedural Myocardial Injury in Patients With Chronic Coronary Syndrome. J Am Heart Assoc 2024; 13:e031209. [PMID: 38240235 PMCID: PMC11056154 DOI: 10.1161/jaha.123.031209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/15/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Perivascular inflammation contributes to the development of atherosclerosis and microcirculatory dysfunction. Pericoronary adipose tissue (PCAT) attenuation, measured by coronary computed tomography angiography, is a potential indicator of coronary inflammation. However, the relationship between PCAT attenuation, microcirculatory dysfunction, and periprocedural myocardial injury (PMI) remains unclear. METHODS AND RESULTS Patients with chronic coronary syndrome who underwent coronary computed tomography angiography before percutaneous coronary intervention were retrospectively identified. PCAT attenuation and adverse plaque characteristics were assessed using coronary computed tomography angiography. The extent of microcirculatory dysfunction was evaluated using the angio-based index of microcirculatory resistance before and after percutaneous coronary intervention. Overall, 125 consecutive patients were included, with 50 experiencing PMI (PMI group) and 75 without PMI (non-PMI group). Multivariable analysis showed that older age, higher angio-based index of microcirculatory resistance, presence of adverse plaque characteristics, and higher lesion-based PCAT attenuation were independently associated with PMI occurrence (odds ratio [OR], 1.07 [95% CI, 1.01-1.13]; P=0.02; OR, 1.06 [95% CI, 1.00-1.12]; P=0.04; OR, 6.62 [95% CI, 2.13-20.6]; P=0.001; and OR, 2.89 [95% CI, 1.63-5.11]; P<0.001, respectively). High PCAT attenuation was correlated with microcirculatory dysfunction before and after percutaneous coronary intervention and its exacerbation during percutaneous coronary intervention. Adding lesion-based PCAT attenuation to the presence of adverse plaque characteristics improved the discriminatory and reclassification ability in predicting PMI. CONCLUSIONS Adding PCAT attenuation at the culprit lesion level to coronary computed tomography angiography-derived adverse plaque characteristics may provide incremental benefit in identifying patients at risk of PMI. Our results highlight the importance of microcirculatory dysfunction in PMI development, particularly in the presence of lesions with high PCAT attenuation. REGISTRATION URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057722; Unique identifier: UMIN000050662.
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Affiliation(s)
- Tetsuya Yamamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Satoru Sasaki
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiroyuki Fujii
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Tomoyo Hamana
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuto Osumi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Seigo Iwane
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Shota Naniwa
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuki Sakamoto
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Koshi Matsuhama
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Yuta Fukuishi
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Ken‐ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Hiromasa Otake
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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Ziedses des Plantes AC, Scoccia A, Gijsen F, van Soest G, Daemen J. Intravascular Imaging-Derived Physiology-Basic Principles and Clinical Application. Cardiol Clin 2024; 42:89-100. [PMID: 37949542 DOI: 10.1016/j.ccl.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Intravascular imaging-derived physiology is emerging as a promising tool allowing simultaneous anatomic and functional lesion assessment. Recently, several optical coherence tomography-based and intravascular ultrasound-based fractional flow reserve (FFR) indices have been developed that compute FFR through computational fluid dynamics, fluid dynamics equations, or machine-learning methods. This review aims to provide an overview of the currently available intravascular imaging-based physiologic indices, their diagnostic performance, and clinical application.
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Affiliation(s)
- Annemieke C Ziedses des Plantes
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Alessandra Scoccia
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Frank Gijsen
- Department of Biomedical Engineering, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Gijs van Soest
- Department of Biomedical Engineering, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Huang X, Li XL, Zhou H, Li XM. Assessment of Angiography-Based Renal Quantitative Flow Ratio Measurement in Patients with Atherosclerotic Renal Artery Stenosis. Cardiovasc Ther 2024; 2024:4618868. [PMID: 38234331 PMCID: PMC10791475 DOI: 10.1155/2024/4618868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/12/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
Background Quantitative flow ratio (QFR) is an angiography-based fractional flow reserve measurement without pressure wire or induction of hyperemia. A recent innovation that uses combined geometrical data and hemodynamic boundary conditions to measure QFR from a single angiographic view has shown the potential to measure QFR of the renal artery-renal QFR (rQFR). Objective The aim of this pilot study was to assess the feasibility of rQFR measurement and the contribution of rQFR in selecting patients with atherosclerotic renal artery stenosis (ARAS) undergoing revascularization. Methods This retrospective trial enrolled patients who had ARAS (50-90%) and hypertension. The enrolled patients were treated by optimal antihypertensive medication or revascularization, respectively, and the therapeutic strategies were based on rFFR measurement and/or clinical feature. Results A total of 55 patients underwent rQFR measurement. Among the enrolled patients, 18 underwent optimal antihypertensive medication and 37 underwent revascularization, 19 patients in whom rQFR and rFFR were both assessed. During the 180-day follow-up, 25 patients saw an improvement in their blood pressure among the 37 patients that underwent revascularization. ROC analysis revealed that rQFR had a high diagnostic accuracy for predicting blood pressure improvement (AUCrQFR = 0.932, 95% CI 0.798-0.998). The ideal cut-off value of rQFR for predicting blood pressure improvement after revascularization is ≤0.72 (sensitivity: 72.00%, specificity: 100%). The paired t test and Bland-Altman analyses demonstrated good agreement between rQFR and rFFR (t = 1.887, 95% CI -0.021 to 0.001, 95% limits of agreement: -0.035 to 0.055, p = 0.075). The Spearman correlation test reveals that there was a significant positive correlation between rQFR and rFFR (r = 0.952, 95% CI 0.874 to 0.982, p < 0.001). Conclusion The rQFR has the potential to enhance the ability of angiography to detect functionally significant renal artery stenosis during angiography and to produce results that are comparable to invasive hemodynamic assessment.
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Affiliation(s)
- Xiang Huang
- Department of Cardiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei, China
| | - Xiao-Lan Li
- Department of Cardiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei, China
| | - Heng Zhou
- Department of Cardiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei, China
| | - Xiao-Mei Li
- Department of Cardiology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang 441000, Hubei, China
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9
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Kotoku N, Ninomiya K, Ding D, O'Leary N, Tobe A, Miyashita K, Masuda S, Kageyama S, Garg S, Leipsic JA, Mushtaq S, Andreini D, Tanaka K, de Mey J, Wijns W, Tu S, Piazza N, Onuma Y, Serruys PW. Murray law-based quantitative flow ratio to assess left main bifurcation stenosis: selecting the angiographic projection matters. Int J Cardiovasc Imaging 2024; 40:195-206. [PMID: 37870715 PMCID: PMC10774209 DOI: 10.1007/s10554-023-02974-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
Murray law-based quantitative flow ratio (µQFR) assesses fractional flow reserve (FFR) in bifurcation lesions using a single angiographic view, enhancing the feasibility of analysis; however, accuracy may be compromised in suboptimal angiographic projections. FFRCT is a well-validated non-invasive method measuring FFR from coronary computed tomographic angiography (CCTA). We evaluated the feasibility of µQFR in left main (LM) bifurcations, the impact of the optimal/suboptimal fluoroscopic view with respect to CCTA, and its diagnostic concordance with FFRCT. In 300 patients with three-vessel disease, the values of FFRCT and µQFR were compared at distal LM, proximal left anterior descending artery (pLAD) and circumflex artery (pLCX). The optimal viewing angle of LM bifurcation was defined on CCTA by 3-dimensional coordinates and converted into a 2-dimensional fluoroscopic view. The best fluoroscopic projection was considered the closest angulation to the optimal viewing angle on CCTA. µQFR was successfully computed in 805 projections. In the best projections, µQFR sensitivity was 88.2% (95% CI 76.1-95.6) and 84.8% (71.1-93.7), and specificity was 96.8% (93.8-98.6) and 97.2% (94.4-98.9), in pLAD and pLCX, respectively, with regard to FFRCT. The AUC of µQFR for predicting FFRCT ≤ 0.80 tended to be improved using the best versus suboptimal projections (0.94 vs. 0.89 [p = 0.048] in pLAD; 0.94 vs. 0.88 [p = 0.075] in pLCX). Computation of µQFR in LM bifurcations using a single angiographic view showed high feasibility from post-hoc analysis of coronary angiograms obtained for clinical purposes. The fluoroscopic viewing angle influences the diagnostic performance of physiological assessment using a single angiographic view.
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Affiliation(s)
- Nozomi Kotoku
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kai Ninomiya
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Daixin Ding
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Neil O'Leary
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Akihiro Tobe
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Kotaro Miyashita
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shinichiro Masuda
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Shigetaka Kageyama
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, UK
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Saima Mushtaq
- Departments of Cardiovascular Imaging and Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Daniele Andreini
- Division of Cardiology and Cardiac Imaging, IRCCS Galeazzi Sant'Ambrogio, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - Johan de Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, VUB, Brussels, Belgium
| | - William Wijns
- The Lambe Institute for Translational Medicine, The Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Nicolo Piazza
- Department of Medicine, Division of Cardiology, McGill University Health Center, Montreal, QC, Canada
| | - Yoshinobu Onuma
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland
| | - Patrick W Serruys
- Department of Cardiology, University of Galway, University Road, Galway, H91 TK33, Ireland.
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10
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Hu T, Qiu Q, Xie N, Sun M, Jia Q, Huang M. Prognostic value of optical flow ratio for cardiovascular outcomes in patients after percutaneous coronary stent implantation. Front Cardiovasc Med 2023; 10:1247053. [PMID: 38155983 PMCID: PMC10753062 DOI: 10.3389/fcvm.2023.1247053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/20/2023] [Indexed: 12/30/2023] Open
Abstract
Background The relationship between the optical flow ratio (OFR) and clinical outcomes in patients with coronary artery disease (CAD) after percutaneous coronary stent implantation (PCI) remains unknown. Objective To examine the correlation between post-PCI OFR and clinical outcomes in patients with CAD following PCI. Methods Patients who underwent optical coherence tomography (OCT) guided PCI at Guangdong Provincial People's Hospital were retrospectively and continuously enrolled. Clinical data, post-PCI OCT characteristics, and OFR measurements were collected and analyzed to identify predictors of target vessel failure (TVF) after PCI. Results Among 354 enrolled patients, 26 suffered TVF during a median follow-up of 484 (IQR: 400-774) days. Post-PCI OFR was significantly lower in the TVF group than in the non-TVF group (0.89 vs. 0.93; P = 0.001). In multivariable Cox regression analysis, post-PCI OFR (HR per 0.1 increase: 0.60; 95% CI: 0.41-0.89; P = 0.011), large stent edge dissection (HR: 3.85; 95% CI: 1.51-9.84; P = 0.005) and thin-cap fibroatheroma (TCFA) (HR: 2.95; 95% CI: 1.19-7.35; P = 0.020) in the non-stented segment were independently associated with TVF. In addition, the inclusion of post-PCI OFR to baseline characteristics and post-PCI OCT findings improved the predictive power of the model to distinguish subsequent TVF after PCI (0.838 vs. 0.796; P = 0.028). Conclusion The post-PCI OFR serves as an independent determinant of risk for TVF in individuals with CAD after PCI. The inclusion of post-PCI OFR assessments, alongside baseline characteristics and post-PCI OCT findings, substantially enhances the capacity to differentiate the subsequent manifestation of TVF in CAD patients following PCI.
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Affiliation(s)
- Tianyu Hu
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qinghua Qiu
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Nianjin Xie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Mingming Sun
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Qianjun Jia
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Meiping Huang
- Department of Catheterization Lab, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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11
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Liu W, Cai H, Zheng Y, Wen Y, Chen S, Xie X, Zeng H, Zhu H, Ni Z, Pei F, Cao J, Cao G. Predictive Value of Post-Percutaneous Coronary Intervention Quantitative Flow Ratio for Vessel-Oriented Composite Endpoint. J Interv Cardiol 2023; 2023:2438347. [PMID: 37720628 PMCID: PMC10505082 DOI: 10.1155/2023/2438347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 08/08/2023] [Accepted: 08/31/2023] [Indexed: 09/19/2023] Open
Abstract
At present, there is a lack of indicators, which can accurately predict the post-percutaneous coronary intervention (post-PCI) vessel-oriented composite endpoint (VOCE). Recent studies showed that the post-PCI quantitative flow ratio (QFR) can predict post-PCI VOCE. PubMed, Embase, and Cochrane were searched from inception to March 27, 2022, and the cohort studies about that the post-PCI QFR predicts post-PCI VOCE were screened. Meta-analysis was performed, including 6 studies involving 4518 target vessels. The results of the studies included in this meta-analysis all showed that low post-PCI QFR was an independent risk factor for post-PCI VOCE after adjusting for other factors, HR (95% CI) ranging from 2.718 (1.347-5.486) to 6.53 (2.70-15.8). Our meta-analysis showed that the risk of post-PCI VOCE was significantly higher in the lower post-PCI QFR group than in the higher post-PCI QFR group (HR: 4.14, 95% CI: 3.00-5.70, P < 0.001, I2 = 27.9%). Post-PCI QFR has a good predictive value for post-PCI VOCE. Trial Registration. This trial is registered with CRD42022322001.
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Affiliation(s)
- Weibin Liu
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou 341000, China
| | - Huaxiu Cai
- Department of Cardiology, Ganzhou People's Hospital, Ganzhou 341000, China
| | - Yin Zheng
- Gannan Medical University, Ganzhou 341000, China
| | - Yongkang Wen
- Gannan Medical University, Ganzhou 341000, China
| | - Sicheng Chen
- Gannan Medical University, Ganzhou 341000, China
| | - Xiuying Xie
- Department of General Practice, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Huan Zeng
- Department of Radiology and Imaging, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Hengqing Zhu
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Zhonghan Ni
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Fang Pei
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Jun Cao
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
| | - Gang Cao
- Department of Cardiology, Ganzhou Hospital of Guangdong Provincial People's Hospital, Ganzhou Municipal Hospital, Ganzhou 341000, China
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12
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Kan J, Ge Z, Nie S, Gao X, Li X, Sheiban I, Zhang JJ, Chen SL. Clinical prognostic value of a novel quantitative flow ratio from a single projection in patients with coronary bifurcation lesions treated with the provisional approach. ASIAINTERVENTION 2023; 9:114-123. [PMID: 37736199 PMCID: PMC10507452 DOI: 10.4244/aij-d-22-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 01/11/2023] [Indexed: 09/23/2023]
Abstract
Background A novel quantitative flow ratio (μQFR) for bifurcated coronary vessels, derived from a single projection, has been recently reported. Provisional stenting is effective for most bifurcation lesions. However, the clinical value of the side branch (SB) μQFR in patients with coronary bifurcation lesions undergoing provisional stenting remains unclear. Aims This study aims to determine the clinical predictive value of the SB μQFR after provisional stenting in patients with coronary bifurcation lesions. Methods Between June 2015 and May 2018, 288 patients with true coronary bifurcation lesions who underwent a provisional approach without SB treatment (including predilation, kissing balloon inflation or stenting) were classified by an SB μQFR <0.8 (n=65) and ≥0.8 (n=223) groups. The primary endpoint was the three-year composite of target vessel failure (TVF), including cardiac death, target vessel myocardial infarction (TVMI), and revascularisation (TVR). Results Three years after the procedures, there were 43 (14.9%) TVFs, with 19 (29.2%) in the SB μQFR <0.8 and 24 (10.8%) in the SB μQFR ≥0.8 groups (adjusted hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.39-5.54; p=0.003), mainly driven by increased TVMI (16.9% vs 5.4%, adjusted HR 3.29, 95% CI: 1.15-6.09; p=0.030) and TVR (15.4% vs 2.2%, adjusted HR 6.39, 95% CI: 2.04-13.48; p=0.007). Baseline diameter stenosis at the ostial SB and SB lesion length were the two predictors of an SB μQFR <0.8 immediately after stenting the main vessel, whereas previous percutaneous coronary intervention and an SB μQFR <0.8 were the two independent factors of 3-year TVF. Conclusions An SB μQFR <0.8 immediately after the provisional approach is strongly associated with clinical events. Further randomised studies with large patient populations are warranted.
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Affiliation(s)
- Jing Kan
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Zhen Ge
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Shaoping Nie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | | | - Xiaobo Li
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Imad Sheiban
- Division of Cardiology, Pederzoli Hospital-Peschiera del Garda, Verona, Italy
| | - Jun-Jie Zhang
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
| | - Shao-Liang Chen
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, People's Republic of China
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13
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Hu F, Ding D, Westra J, Li Y, Yu W, Wang Z, Kubo T, Chico JLG, Chen Y, Wijns W, Tu S. Diagnostic accuracy of optical flow ratio: an individual patient-data meta-analysis. EUROINTERVENTION 2023; 19:e145-e154. [PMID: 36950895 PMCID: PMC10242661 DOI: 10.4244/eij-d-22-01098] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 01/18/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Optical flow ratio (OFR) is a novel method for the fast computation of fractional flow reserve (FFR) from optical coherence tomography. AIMS We aimed to evaluate the diagnostic accuracy of OFR in assessing intermediate coronary stenosis using wire-based FFR as the reference. METHODS We performed an individual patient-level meta-analysis of all available studies with paired OFR and FFR assessments. The primary outcome was vessel-level diagnostic concordance of the OFR and FFR, using a cut-off of ≤0.80 to define ischaemia and ≤0.90 to define suboptimal post-percutaneous coronary intervention (PCI) physiology. This meta-analysis was registered in PROSPERO (CRD42021287726). RESULTS Five studies were finally included, providing 574 patients and 626 vessels (404 pre-PCI and 222 post-PCI) with paired OFR and FFR from 9 international centres. Vessel-level diagnostic concordance of the OFR and FFR was 91% (95% confidence interval [CI]: 88%-94%), 87% (95% CI: 82%-91%), and 90% (95% CI: 87%-92%) in pre-PCI, post-PCI, and overall, respectively. The overall sensitivity, specificity, and positive and negative predictive values were 84% (95% CI: 79%-88%), 94% (95% CI: 92%-96%), 90% (95% CI: 86%-93%), and 89% (95% CI: 86%-92%), respectively. Multivariate logistic regression indicated that a low pullback speed (odds ratio [OR] 7.02, 95% CI: 1.68-29.43; p=0.008) was associated with a higher risk of obtaining OFR values at least 0.10 higher than FFR. Increasing the minimal lumen area was associated with a lower risk of obtaining an OFR at least 0.10 lower than FFR (OR 0.39, 95% CI: 0.18-0.82; p=0.013). CONCLUSIONS This individual patient data meta-analysis demonstrated a high diagnostic accuracy of OFR. OFR has the potential to provide an improved integration of intracoronary imaging and physiological assessment for the accurate evaluation of coronary artery disease.
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Affiliation(s)
- Fukang Hu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Daixin Ding
- The Lambe Institute for Translational Research, Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yingguang Li
- Kunshan Industrial Technology Research Institute, Suzhou, People's Republic of China
| | - Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zhiqing Wang
- Department of Cardiology, Fujian Medical University Union Hospital, Fujian, China
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | | | - Yundai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - William Wijns
- The Lambe Institute for Translational Research, Smart Sensors Laboratory and CURAM, University of Galway, Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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14
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Caullery B, Riou L, Barone-Rochette G. Coronary Angiography Upgraded by Imaging Post-Processing: Present and Future Directions. Diagnostics (Basel) 2023; 13:diagnostics13111978. [PMID: 37296830 DOI: 10.3390/diagnostics13111978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Advances in computer technology and image processing now allow us to obtain from angiographic images a large variety of information on coronary physiology without the use of a guide-wire as a diagnostic information equivalent to FFR and iFR but also information allowing for the performance of a real virtual percutaneous coronary intervention (PCI) and finally the ability to obtain information to optimize the results of PCI. With specific software, it is now possible to have a real upgrading of invasive coronary angiography. In this review, we present the different advances in this field and discuss the future perspectives offered by this technology.
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Affiliation(s)
- Benoit Caullery
- Department of Cardiology, University Hospital, 38000 Grenoble, France
| | - Laurent Riou
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000 Grenoble, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, 38000 Grenoble, France
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, 38000 Grenoble, France
- French Clinical Research Infrastructure Network, 75018 Paris, France
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15
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Reddy MSH, Maddury J, Mamas MA, Assa HV, Kornowski R. Coronary Physiologic Assessment Based on Angiography and Intracoronary Imaging. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/ijcdw_15_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Intracoronary physiology testing has evolved as a promising diagnostic approach in the management of patients with coronary artery disease. The value of hyperemic translesional pressure ratios to estimate the functional relevance of coronary stenoses is supported by a wealth of outcomes data. The continuing drive to further simplify this approach led to the development of non-hyperemic pressure-based indices. Recent attention has focused on estimating functional significance without invasively measuring coronary pressure through the measurement of virtual indices derived from the coronary angiogram. By offering a routine assessment of the physiology of all the major epicardial coronary vessels, angiogram-derived physiology has the potential to modify current practice by facilitating more accurate patient-level, vessel-level, and even lesion-level decision making. This article reviews the current state of angiogram-derived physiology and speculates on its potential impact on clinical practice, in continuation to the previously published article on coronary physiology in this journal.
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Affiliation(s)
- M. S. Harish Reddy
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Jyotsna Maddury
- Department of Cardiology, Nizams Institute of Medical Sciences, Hyderabad, Telangana, India,
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke on Trent, United Kingdom,
| | - Hana Vaknin Assa
- Department of Interventional Cardiology, Rabin Medical Center (RMC), Petach Tikva, Israel,
| | - Ran Kornowski
- Department of Director of Cardiology Division, Rabin Medical Center (RMC), Petach Tikva, Israel,
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16
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Ziedses des Plantes AC, Scoccia A, Gijsen F, van Soest G, Daemen J. Intravascular Imaging-Derived Physiology-Basic Principles and Clinical Application. Interv Cardiol Clin 2023; 12:83-94. [PMID: 36372464 DOI: 10.1016/j.iccl.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Intravascular imaging-derived physiology is emerging as a promising tool allowing simultaneous anatomic and functional lesion assessment. Recently, several optical coherence tomography-based and intravascular ultrasound-based fractional flow reserve (FFR) indices have been developed that compute FFR through computational fluid dynamics, fluid dynamics equations, or machine-learning methods. This review aims to provide an overview of the currently available intravascular imaging-based physiologic indices, their diagnostic performance, and clinical application.
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Affiliation(s)
- Annemieke C Ziedses des Plantes
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Alessandra Scoccia
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Frank Gijsen
- Department of Biomedical Engineering, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Gijs van Soest
- Department of Biomedical Engineering, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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17
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Liu Z, Yang J, Chen Y. The Chinese Experience of Imaging in Cardiac Intervention: A Bird's Eye Review. J Thorac Imaging 2022; 37:374-384. [PMID: 36162061 DOI: 10.1097/rti.0000000000000680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent scientific and technological advances have greatly contributed to the development of medical imaging that could enable specific functions. It has become the primary focus of cardiac intervention in preoperative assessment, intraoperative guidance, and postoperative follow-up. This review provides a contemporary overview of the Chinese experience of imaging in cardiac intervention in recent years.
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Affiliation(s)
- Zinuan Liu
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
- Medical School of Chinese PLA, Beijing, P.R. China
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital
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18
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In Vivo Validation of a Novel Computational Approach to Assess Microcirculatory Resistance Based on a Single Angiographic View. J Pers Med 2022; 12:jpm12111798. [PMID: 36573725 PMCID: PMC9692562 DOI: 10.3390/jpm12111798] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
(1) Background: In spite of the undeniable clinical value of the index of microvascular resistance (IMR) in assessing the status of coronary microcirculation, its use globally remains very low. The aim of this study was to validate the novel single-view, pressure-wire- and adenosine-free angiographic microvascular resistance (AMR) index, having the invasive wire-based IMR as a reference standard. (2) Methods: one hundred and sixty-three patients (257 vessels) were investigated with pressure wire-based IMR. Microvascular dysfunction (CMD) was defined by IMR ≥ 25. AMR was independently computed from the diagnostic coronary angiography in a blinded fashion. (3) Results: AMR demonstrated a good correlation (r = 0.83, p < 0.001) and diagnostic performance (AUC 0.94; 95% CI: 0.91 to 0.97) compared with wire-based IMR. The best cutoff value for AMR in determining IMR ≥ 25 was 2.5 mmHg*s/cm. The overall diagnostic accuracy of AMR was 87.2% (95% CI: 83.0% to 91.3%), with a sensitivity of 93.5% (95% CI: 87.0% to 97.3%), a specificity of 82.7% (95% CI: 75.6% to 88.4%), a positive predictive value of 79.4% (95% CI: 71.2% to 86.1%) and a negative predictive value of 94.7% (95% CI: 89.3% to 97.8%). No difference in terms of CMD rate was described among different clinical presentations. (4) Conclusions: AMR derived solely from a single angiographic view is a feasible computational alternative to pressure wire-based IMR, with good diagnostic accuracy in assessing CMD.
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Guan S, Gan Q, Han W, Zhai X, Wang M, Chen Y, Zhang L, Li T, Chang X, Liu H, Hong W, Li Z, Tu S, Qu X. Feasibility of Quantitative Flow Ratio Virtual Stenting for Guidance of Serial Coronary Lesions Intervention. J Am Heart Assoc 2022; 11:e025663. [PMID: 36129050 PMCID: PMC9673740 DOI: 10.1161/jaha.122.025663] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Coronary physiology measurement in serial coronary lesions with multiple stenoses is challenging. Therefore, we evaluated the feasibility of Murray fractal law‐based quantitative flow ratio (μQFR) virtual stenting for guidance of serial coronary lesions intervention. Methods and Results Patients who underwent elective coronary angiography and had 2 serial de novo coronary lesions of 30% to 90% diameter stenosis by visual estimation were prospectively enrolled. μQFR and fractional flow reserve (FFR) were assessed after coronary angiography. In vessels with an FFR ≤0.80, the lesion with the larger pressure gradient was considered to be the primary lesion and treated firstly, followed by FFR measurement. The second lesion was stented when FFR ≤0.80. All μQFR and predicted μQFR after stenting were calculated from diagnostic coronary angiography before interventions, with the analysts masked to the FFR data. A total of 54 patients with 61 target vessels were interrogated. Percutaneous coronary intervention was performed in 44 vessels with FFR ≤0.80. After stenting the primary lesions, 14 nonprimary lesions had FFR ≤0.80 and a second drug‐eluting stent was implanted. There was excellent correlation (r=0.97, P<0.001) and good agreement (mean difference: 0.00±0.03) between baseline μQFR and FFR in identifying flow‐limiting lesions. Per‐vessel diagnostic accuracy of μQFR on de novo lesions was 96.7% (95% CI, 88.7%–99.6%). μQFR and FFR are highly consistent (93.2%) in identifying the primary lesion requiring revascularization. After stenting the primary lesions, per‐vessel diagnostic accuracy of predicted μQFR for identifying the significance of the nonprimary lesion was 90.9%. Predicted residual μQFR with virtual stenting was higher than final FFR (mean difference: 0.05±0.06). Conclusions In vessels with serial coronary lesions, virtual stenting by μQFR can identify the primary flow‐limiting lesion for revascularization.
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Affiliation(s)
- Shaofeng Guan
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Qian Gan
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Wenzheng Han
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Xinrong Zhai
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Ming Wang
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Yang Chen
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Liang Zhang
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Tianqi Li
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Xifeng Chang
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Hongyuan Liu
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Weilin Hong
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
| | - Zehang Li
- Shanghai Jiao Tong University-Pulse Medical Imaging Joint Laboratory Shanghai China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
| | - Xinkai Qu
- Department of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai China.,Shanghai Key Laboratory of Clinical Geriatric Medicine Shanghai China
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20
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Ding D, Tu S, Chang Y, Li C, Xu B, Wijns W. Quantitative Flow Ratio Based on Murray Fractal Law: Accuracy of Single Versus Two Angiographic Views. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100399. [PMID: 39131462 PMCID: PMC11307523 DOI: 10.1016/j.jscai.2022.100399] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 08/13/2024]
Abstract
Background Murray bifurcation fractal law-based quantitative flow ratio (QFR), namely, μQFR, is a novel method for the fast computation of fractional flow reserve (FFR) from a single angiographic view. We aimed to compare the diagnostic accuracy of computational QFR based on single vs 2 angiographic views in patients with intermediate coronary stenosis. Methods The algorithm of μQFR was extended to develop a Murray law-based 3-dimensional (3D) μQFR from 2 angiographic projections. Patients with both angiographic views acquired according to the protocol-specified recommended views in the FAVOR (Functional Diagnostic Accuracy of Quantitative Flow Ratio in Online Assessment of Coronary Stenosis) II China study were included. μQFR was computed separately from the first (μQFR1) and second (μQFR2) angiographic projections, whereas the 3D-μQFR was computed based on both projections, all blinded to FFR data. Hemodynamically significant coronary stenosis was defined by wire-based FFR of ≤0.80. Results Altogether, 280 vessels from 262 patients had 2 protocol-specified recommended angiographic views; μQFR1, μQFR2, and 3D-μQFR were successfully computed in all these vessels. The mean FFR was 0.82 ± 0.12. The vessel-level diagnostic accuracy for μQFR1, μQFR2, and 3D-μQFR to identify hemodynamically significant stenosis was 92.1% (95% CI, 89.0%-95.3%), 92.5% (95% CI, 89.4%-95.6%), and 93.2% (95% CI, 90.3%-96.2%), respectively, with similar areas under the receiver operating characteristic curve for μQFR1 (0.96, P < .001), μQFR2 (0.95, P < .001), and 3D-μQFR (0.95, P < .001). μQFR1 and μQFR2 had excellent correlation (r = 0.95) and agreement (mean difference = 0.00 ± 0.03). Conclusions Computation of μQFR from a single angiographic view had comparably good diagnostic performance as 2-view 3D-μQFR in identifying hemodynamically significant coronary stenosis.
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Affiliation(s)
- Daixin Ding
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, National University of Ireland Galway, Ireland
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yunxiao Chang
- Shanghai Pulse Medical Technology Inc., Shanghai, China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Xu
- Catheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - William Wijns
- The Lambe Institute for Translational Medicine, Smart Sensors Laboratory and Curam, National University of Ireland Galway, Ireland
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21
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Altstidl JM, Achenbach S, Marwan M, Tröbs M, Schacher N, Ferstl P, Gerlach A, Schlundt C, Gaede L. Comparison of adenosine-independent pressure indices to fractional flow reserve in stent-jailed bifurcation side branches. Catheter Cardiovasc Interv 2022; 100:369-377. [PMID: 35723275 DOI: 10.1002/ccd.30298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 05/14/2022] [Accepted: 05/29/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVES AND BACKGROUND This study aims to evaluate whether the high correlation and classification agreement of the instantaneous wave-free ratio (iFR) and the resting distal coronary to aortic pressure ratio (Pd /Pa ) with the fractional flow reserve (FFR) can be confirmed in stent-jailed side branches (J-SB). METHODS Consecutive patients (n = 49) undergoing provisional stenting were prospectively enrolled and a physiological assessment of the J-SB (n = 51) was performed. FFR, iFR, and Pd /Pa were measured and the hemodynamic relevance was determined using cutoff values of ≤0.80, ≤0.89, and ≤0.92, respectively. RESULTS Both iFR (r = 0.75) and Pd /Pa (r = 0.77) correlated closely with FFR. Classification agreement with FFR was 78% for iFR (81% sensitivity, 77% specificity) and 75% for Pd /Pa (63% sensitivity and 80% specificity). However, angiographic diameter stenosis and pressure indices correlated poorly. For a threshold of ≥70% stenosis, agreement concerning hemodynamic relevance was found in 59% for FFR, 69% for iFR, and 61% for Pd /Pa . CONCLUSION As reported for other lesion types, FFR and the adenosine-independent pressure indices iFR and Pd /Pa show close correlation and a high classification agreement of approximately 75%-80% in J-SB. Therefore, iFR can be regarded as a recommendable alternative to FFR for the guidance of provisional stenting in bifurcation lesions.
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Affiliation(s)
- Johannes Michael Altstidl
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephan Achenbach
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Mohamed Marwan
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Monique Tröbs
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nora Schacher
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Paul Ferstl
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas Gerlach
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Christian Schlundt
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Luise Gaede
- Department of Medicine 2 - Cardiology and Angiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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22
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Huang K, Yao W, Du J, Wang F, Han Y, Chang Y, Liu R, Ye R, Zhu W, Tu S, Liu X. Functional Assessment of Cerebral Artery Stenosis by Angiography-Based Quantitative Flow Ratio: A Pilot Study. Front Aging Neurosci 2022; 14:813648. [PMID: 35177976 PMCID: PMC8845469 DOI: 10.3389/fnagi.2022.813648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increasing attention has been paid to the hemodynamic evaluation of cerebral arterial stenosis. We aimed to demonstrate the performance of angiography-based quantitative flow ratio (QFR) to assess hemodynamic alterations caused by luminal stenoses, using invasive fractional pressure ratios (FPRs) as a reference standard. Methods Between March 2013 and December 2019, 29 patients undergoing the pressure gradient measurement of cerebral atherosclerosis were retrospectively enrolled. Wire-based FPR was defined by the arterial pressure distal to the stenotic lesion (Pd) to proximal (Pa) pressure ratios (Pd/Pa). FPR < 0.70 or FPR < 0.75 was assumed as hemodynamically significant stenosis. The new method of computing QFR from a single angiographic view, i.e., the Murray law-based QFR, was applied to the interrogated vessel. An artificial intelligence algorithm was developed to realize the automatic delineation of vascular contour. Results Fractional pressure ratio and QFR were assessed in 38 vessels from 29 patients. Excellent correlation and agreement were observed between QFR and FPR [r = 0.879, P < 0.001; mean difference (bias): −0.006, 95% limits of agreement: −0.198 to 0.209, respectively). Intra-observer and inter-observer reliability in QFR were excellent (intra-class correlation coefficients, 0.996 and 0.973, respectively). For predicting FPR < 0.70, the area under the receiver-operating characteristic curves (AUC) of QFR was 0.946 (95% CI, 0.820 to 0.993%). The sensitivity and specificity of QFR < 0.70 for identifying FPR < 0.70 was 88.9% (95% CI, 65.3 to 98.6%) and 85.0% (95% CI, 62.1 to 96.8%). For predicting FPR < 0.75, QFR showed similar performance with an AUC equal to 0.926. Conclusion Computational QFR from a single angiographic view achieved comparable results to the wire-based FPR. The excellent diagnostic performance and repeatability empower QFR with high feasibility in the functional assessment of cerebral arterial stenosis.
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Affiliation(s)
- Kangmo Huang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weihe Yao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Juan Du
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Pulse Medical Imaging Technology, Shanghai, China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wusheng Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Shengxian Tu,
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Xinfeng Liu,
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23
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Liu X, Vardhan M, Wen Q, Das A, Randles A, Chi EC. An Interpretable Machine Learning Model to Classify Coronary Bifurcation Lesions. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4432-4435. [PMID: 34892203 DOI: 10.1109/embc46164.2021.9631082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Coronary bifurcation lesions are a leading cause of Coronary Artery Disease (CAD). Despite its prevalence, coronary bifurcation lesions remain difficult to treat due to our incomplete understanding of how various features of lesion anatomy synergistically disrupt normal hemodynamic flow. In this work, we employ an interpretable machine learning algorithm, the Classification and Regression Tree (CART), to model the impact of these geometric features on local hemodynamic quantities. We generate a synthetic arterial database via computational fluid dynamic simulations and apply the CART approach to predict the time averaged wall shear stress (TAWSS) at two different locations within the cardiac vasculature. Our experimental results show that CART can estimate a simple, interpretable, yet accurately predictive nonlinear model of TAWSS as a function of such features.Clinical relevance- The fitted tree models have the potential to refine predictions of disturbed hemodynamic flow based on an individual's cardiac and lesion anatomy and consequently makes progress towards personalized treatment planning for CAD patients.
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24
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Masdjedi K, van Zandvoort LJC, Balbi MM, Nuis R, Wilschut J, Diletti R, de Jaegere PP, Zijlstra F, Van Mieghem NM, Daemen J. Validation of novel 3-dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting. Catheter Cardiovasc Interv 2021; 98:671-677. [PMID: 33022098 PMCID: PMC8519140 DOI: 10.1002/ccd.29311] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 08/02/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To validate novel dedicated 3D-QCA based on the software to calculate post PCI vessel-FFR (vFFR) in a consecutive series of patients, to assess the diagnostic accuracy, and to assess inter-observer variability. BACKGROUND Low post percutaneous coronary intervention (PCI) fractional flow reserve (FFR) predicts future adverse cardiac events. However, FFR assessment requires the insertion of a pressure wire in combination with the use of a hyperemic agent. METHODS FAST POST study is an observational, retrospective, single-center cohort study. One hundred patients presenting with stable angina or non ST-elevation myocardial infarction, who underwent post PCI FFR assessment using a dedicated microcatheter were included. Two orthogonal angiographic projections were acquired to create a 3D reconstruction of the coronary artery using the CAAS workstation 8.0. vFFR was subsequently calculated using the aortic root pressure. RESULTS Mean age was 65±12 years and 70% were male. Mean microcatheter based FFR and vFFR were 0.91±0.07 and 0.91±0.06, respectively. A good linear correlation was found between FFR and vFFR (r = 0.88; p <.001). vFFR had a higher accuracy in the identification of patients with FFR values <0.90, AUC 0.98 (95% CI: 0.96-1.00) as compared with 3D-QCA AUC 0.62 (95% CI: 0.94-0.74). Assessment of vFFR had a low inter-observer variability (r = 0.95; p <.001). CONCLUSION 3D-QCA derived post PCI vFFR correlates well with invasively measured microcatheter based FFR and has a high diagnostic accuracy to detect FFR <0.90 with low inter-observer variability.
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Affiliation(s)
- Kaneshka Masdjedi
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | | | - Matthew M Balbi
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Rutger‐Jan Nuis
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Jeroen Wilschut
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Roberto Diletti
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Peter P.T. de Jaegere
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Felix Zijlstra
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Nicolas M Van Mieghem
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
| | - Joost Daemen
- Department of cardiologyThoraxcenter, Erasmus Medical CenterRotterdamThe Netherlands
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25
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Tu S, Westra J, Adjedj J, Ding D, Liang F, Xu B, Holm NR, Reiber JHC, Wijns W. Fractional flow reserve in clinical practice: from wire-based invasive measurement to image-based computation. Eur Heart J 2021; 41:3271-3279. [PMID: 31886479 DOI: 10.1093/eurheartj/ehz918] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 07/27/2019] [Accepted: 12/04/2019] [Indexed: 01/07/2023] Open
Abstract
Fractional flow reserve (FFR) and instantaneous wave-free ratio are the present standard diagnostic methods for invasive assessment of the functional significance of epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, there remains a gap between guideline recommendations and the clinical adoption of functional evaluation of stenosis severity. A number of image-based approaches have been proposed to compute FFR without the use of pressure wire and induced hyperaemia. In order to better understand these emerging technologies, we sought to highlight the principles, diagnostic performance, clinical applications, practical aspects, and current challenges of computational physiology in the catheterization laboratory. Computational FFR has the potential to expand and facilitate the use of physiology for diagnosis, procedural guidance, and evaluation of therapies, with anticipated impact on resource utilization and patient outcomes.
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Affiliation(s)
- Shengxian Tu
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, Shanghai 200030, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Julien Adjedj
- Cardiology Department, Arnault Tzanck Institute, 171 Rue du Commandant Gaston Cahuzac, 06700 Saint-Laurent-du-Var, France.,Cardiology Department, CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Daixin Ding
- School of Biomedical Engineering, Shanghai Jiao Tong University, No. 1954 Hua Shan Road, Shanghai 200030, China
| | - Fuyou Liang
- School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China.,Institute for Personalized Medicine, Sechenov University, 8-2 Trubetskaya st., Moscow 119991, Russia
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, National Clinical Research Center for Cardiovascular Diseases, A 167, Beilishi Road, Xicheng District, Beijing 100037, China
| | - Niels Ramsing Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Johan H C Reiber
- Division of Image Processing, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway, University Road, Galway H91 TK3, Ireland
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26
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DE Maria GL, Wopperer S, Kotronias R, Shanmuganathan M, Scarsini R, Terentes-Printzios D, Banning AP, Garcia-Garcia HM. From anatomy to function and then back to anatomy: invasive assessment of myocardial ischemia in the catheterization laboratory based on anatomy-derived indices of coronary physiology. Minerva Cardiol Angiol 2021; 69:626-640. [PMID: 33703856 DOI: 10.23736/s2724-5683.20.05486-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
For many decades, the severity of coronary artery disease (CAD) and the indication to proceed with either percutaneous coronary intervention (PCI) or surgical revascularization has been based on anatomically derived parameters of vessel stenosis, and typically on the percentage of lumen diameter stenosis (DS%) as determined by invasive coronary angiography (CA). However, it is currently a well-accepted concept that pre-specified thresholds of DS% have a weak correlation with the ischemic and functional potential of an epicardial coronary stenosis. In this regard, the introduction of fractional-flow reserve (FFR) has represented a paradigm-shift in the understanding, diagnosis, and treatment of CAD, but the adoption of FFR into the clinical practice remains surprisingly limited and sub-standard, probably because of the inherent drawbacks of pressure-wire-based technology such as additional costs, prolonged procedural time, invasive instrumentation of the target vessel, and use of vaso-dilatory agents causing side effects for patients. For this reason, new modalities are under development or validation to derive FFR from computational fluid dynamics (CFD) applied to a three-dimensional model (3D) of the target vessel obtained from CA, intravascular imaging, or coronary computed tomography angiography. The purpose of this review was to describe the technical details of these anatomy-derived indices of coronary physiology with a special focus on summarizing their workflow, available evidence, and future perspectives about their application in the clinical practice.
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Affiliation(s)
- Giovanni L DE Maria
- Oxford Heart Center, John Radcliffe Hospital, Oxford, UK - .,Oxford University Hospitals - NHS Foundation Trust, Oxford, UK -
| | - Samuel Wopperer
- MedStar Washington Hospital Center, Department of Interventional Cardiology, Washington DC, WA, USA
| | - Rafail Kotronias
- Oxford Heart Center, John Radcliffe Hospital, Oxford, UK.,Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Mayooran Shanmuganathan
- Oxford Heart Center, John Radcliffe Hospital, Oxford, UK.,Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Roberto Scarsini
- Oxford Heart Center, John Radcliffe Hospital, Oxford, UK.,Oxford University Hospitals - NHS Foundation Trust, Oxford, UK.,Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Dimitrios Terentes-Printzios
- Oxford Heart Center, John Radcliffe Hospital, Oxford, UK.,Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Adrian P Banning
- Oxford Heart Center, John Radcliffe Hospital, Oxford, UK.,Oxford University Hospitals - NHS Foundation Trust, Oxford, UK
| | - Hector M Garcia-Garcia
- MedStar Washington Hospital Center, Department of Interventional Cardiology, Washington DC, WA, USA
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27
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Tu S, Ding D, Chang Y, Li C, Wijns W, Xu B. Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: A novel method based on bifurcation fractal law. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1040-1047. [DOI: 10.1002/ccd.29592] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/16/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Affiliation(s)
- 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
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Galway Ireland
| | - Yunxiao Chang
- Division of Scientific Research Pulse Medical Imaging Technology Co., Ltd. Shanghai China
| | - Chunming Li
- Biomedical Instrument Institute, School of Biomedical Engineering Shanghai Jiao Tong University Shanghai China
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam National University of Ireland Galway Galway Ireland
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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28
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Yu W, Tanigaki T, Ding D, Wu P, Du H, Ling L, Huang B, Li G, Yang W, Zhang S, Yan F, Okubo M, Xu B, Matsuo H, Wijns W, Tu S. Accuracy of Intravascular Ultrasound-Based Fractional Flow Reserve in Identifying Hemodynamic Significance of Coronary Stenosis. Circ Cardiovasc Interv 2021; 14:e009840. [PMID: 33541105 DOI: 10.1161/circinterventions.120.009840] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasonic flow ratio (UFR) is a novel method for fast computation of fractional flow reserve (FFR) from intravascular ultrasound images. The objective of this study is to evaluate the diagnostic performance of UFR using wire-based FFR as the reference. METHODS Post hoc computation of UFR was performed in consecutive patients with both intravascular ultrasound and FFR measurement in a core lab while the analysts were blinded to FFR. RESULTS A total of 167 paired comparisons between UFR and FFR from 94 patients were obtained. Median FFR was 0.80 (interquartile range, 0.68-0.89) and 50.3% had a FFR≤0.80. Median UFR was 0.81 (interquartile range, 0.69-0.91), and UFR showed strong correlation with FFR (r=0.87; P<0.001). The area under the curve was higher for UFR than intravascular ultrasound-derived minimal lumen area (0.97 versus 0.89, P<0.001). The diagnostic accuracy, sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio for UFR to identify FFR≤0.80 was 92% (95% CI, 87-96), 91% (95% CI, 82-96), 96% (95% CI, 90-99), 96% (95% CI, 89-99), 91% (95% CI, 93-96), 25.0 (95% CI, 8.2-76.2), and 0.10 (95% CI, 0.05-0.20), respectively. The agreement between UFR and FFR was independent of lesion locations (P=0.48), prior myocardial infarction (P=0.29), and imaging catheters (P=0.22). Intraobserver and interobserver variability of UFR analysis was 0.00±0.03 and 0.01±0.03, respectively. Median UFR analysis time was 102 (interquartile range, 87-122) seconds. CONCLUSIONS UFR had a strong correlation and good agreement with FFR. The fast computational time and excellent analysis reproducibility of UFR bears the potential of a wider adoption of integration of coronary imaging and physiology in the catheterization laboratory.
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Affiliation(s)
- Wei Yu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (T.T., M.O., H.M.)
| | - Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway (D.D., W.W.)
| | - Peng Wu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Haiyan Du
- School of Biomedical Engineering, Southern Medical University, China (H.D., W.Y.)
| | - Li Ling
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Biao Huang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Guanyu Li
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Wei Yang
- School of Biomedical Engineering, Southern Medical University, China (H.D., W.Y.)
| | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
| | - Fuhua Yan
- Department of Radiology, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, China (F.Y.)
| | - Munenori Okubo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (T.T., M.O., H.M.)
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (B.X.)
- National Clinical Research Center for Cardiovascular Diseases, Beijing, China (B.X.)
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Japan (T.T., M.O., H.M.)
| | - William Wijns
- The Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway (D.D., W.W.)
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, China (W.Y., D.D., P.W., L.L., B.H., G.L., S.Z., S.T.)
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Fang H, Li H, Song S, Pang K, Ai D, Fan J, Song H, Yu Y, Yang J. Motion-flow-guided recurrent network for respiratory signal estimation of x-ray angiographic image sequences. Phys Med Biol 2020; 65:245020. [PMID: 32590382 DOI: 10.1088/1361-6560/aba087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Motion compensation can eliminate inconsistencies of respiratory movement during image acquisitions for precise vascular reconstruction in the clinical diagnosis of vascular disease from x-ray angiographic image sequences. In x-ray-based vascular interventional therapy, motion modeling can simulate the process of organ deformation driven by motion signals to display a dynamic organ on angiograms without contrast agent injection. Automatic respiratory signal estimation from x-ray angiographic image sequences is essential for motion compensation and modeling. The effects of respiratory motion, cardiac impulses, and tremors on structures in the chest and abdomen bring difficulty in extracting accurate respiratory signals individually. In this study, an end-to-end deep learning framework based on a motion-flow-guided recurrent network is proposed to address the aforementioned problem. The proposed method utilizes a convolutional neural network to learn the spatial features of every single frame, and a recurrent neural network to learn the temporal features of the entire sequence. The combination of the two networks can effectively analyze the image sequence to realize respiratory signal estimation. In addition, the motion-flow between consecutive frames is introduced to provide a dynamic constraint of spatial features, which enables the recurrent network to learn better temporal features from dynamic spatial features than from static spatial features. We demonstrate the advantages of our approach on designed datasets which contain coronary and hepatic angiographic sequences with diaphragm structures, and coronary angiographic sequences without diaphragm structures. Our method improves over state-of-the-art manifold-learning-based methods by 85.7%, 81.5% and 75.3% in respiratory signal accuracy metric on these datasets. The results demonstrate that the proposed method can effectively estimate respiratory signals from multiple motion patterns.
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Affiliation(s)
- Huihui Fang
- Beijing Engineering Research Center of Mixed Reality and Advanced Display, School of Optics and Photonics, Beijing Institute of Technology, Beijing 100081, People's Republic of China
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Wu W, Samant S, de Zwart G, Zhao S, Khan B, Ahmad M, Bologna M, Watanabe Y, Murasato Y, Burzotta F, Brilakis ES, Dangas G, Louvard Y, Stankovic G, Kassab GS, Migliavacca F, Chiastra C, Chatzizisis YS. 3D reconstruction of coronary artery bifurcations from coronary angiography and optical coherence tomography: feasibility, validation, and reproducibility. Sci Rep 2020; 10:18049. [PMID: 33093499 PMCID: PMC7582159 DOI: 10.1038/s41598-020-74264-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022] Open
Abstract
The three-dimensional (3D) representation of the bifurcation anatomy and disease burden is essential for better understanding of the anatomical complexity of bifurcation disease and planning of stenting strategies. We propose a novel methodology for 3D reconstruction of coronary artery bifurcations based on the integration of angiography, which provides the backbone of the bifurcation, with optical coherence tomography (OCT), which provides the vessel shape. Our methodology introduces several technical novelties to tackle the OCT frame misalignment, correct positioning of the OCT frames at the carina, lumen surface reconstruction, and merging of bifurcation lumens. The accuracy and reproducibility of the methodology were tested in n = 5 patient-specific silicone bifurcations compared to contrast-enhanced micro-computed tomography (µCT), which was used as reference. The feasibility and time-efficiency of the method were explored in n = 7 diseased patient bifurcations of varying anatomical complexity. The OCT-based reconstructed bifurcation models were found to have remarkably high agreement compared to the µCT reference models, yielding r2 values between 0.91 and 0.98 for the normalized lumen areas, and mean differences of 0.005 for lumen shape and 0.004 degrees for bifurcation angles. Likewise, the reproducibility of our methodology was remarkably high. Our methodology successfully reconstructed all the patient bifurcations yielding favorable processing times (average lumen reconstruction time < 60 min). Overall, our method is an easily applicable, time-efficient, and user-friendly tool that allows accurate and reproducible 3D reconstruction of coronary bifurcations. Our technique can be used in the clinical setting to provide information about the bifurcation anatomy and plaque burden, thereby enabling planning, education, and decision making on bifurcation stenting.
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Affiliation(s)
- Wei Wu
- Cardiovasclar Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, 68105, USA
| | - Saurabhi Samant
- Cardiovasclar Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, 68105, USA
| | - Gijs de Zwart
- StudioGijs, Daendelsstraat 40, 5018 ES, Tilburg, The Netherlands
| | - Shijia Zhao
- Cardiovasclar Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, 68105, USA
| | - Behram Khan
- Cardiovasclar Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, 68105, USA
| | - Mansoor Ahmad
- Cardiovasclar Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, 68105, USA
| | - Marco Bologna
- Biosignals, Bioimaging and Bioinformatics Laboratory (B3-Lab), Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University Hospital, Tokyo, 173-0003, Japan
| | - Yoshinobu Murasato
- Department of Cardiology, National Hospital Organization Kyushu Medical Center, Fukuoka, 810-0065, Japan
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | | | - George Dangas
- Department of Cardiovascular Medicine, Mount Sinai Hospital, New York City, 10029, USA
| | - Yves Louvard
- Institut Cardiovasculaire Paris Sud, 91300, Massy, France
| | - Goran Stankovic
- Department of Cardiology, Clinical Center of Serbia, 11000, Belgrade, Serbia
| | - Ghassan S Kassab
- California Medical Innovation Institute, San Diego, CA, 92121, USA
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta, Politecnico di Milano, 20133, Milan, Italy
| | - Claudio Chiastra
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, 10129, Turin, Italy
| | - Yiannis S Chatzizisis
- Cardiovasclar Biology and Biomechanics Laboratory, Cardiovascular Division, University of Nebraska Medical Center, Omaha, 68105, USA.
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Sheng X, Qiao Z, Ge H, Sun J, He J, Li Z, Ding S, Pu J. Novel application of quantitative flow ratio for predicting microvascular dysfunction after ST-segment-elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 95 Suppl 1:624-632. [PMID: 31912991 DOI: 10.1002/ccd.28718] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/31/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study evaluated quantitative flow ratio (QFR) to predict microvascular dysfunction (MVD) in patients with ST-segment elevation myocardial infarction (STEMI). BACKGROUND QFR is a novel approach for the rapid computation of fractional flow reserve based on three-dimensional quantitative coronary angiography. We hypothesized that QFR computation could be used to predict MVD after STEMI. METHODS Indexes such as contrast-flow QFR (cQFR), fixed-flow QFR (fQFR), and hyperemic flow velocity (HFV) were calculated in 130 STEMI patients with culprit lesion with ≥50% diameter stenosis and TIMI flow grade 2/3 in the spontaneously recanalized culprit artery on initial angiography. MVD was defined as microvascular obstruction determined by contrast-enhanced cardiac magnetic resonance at a median of 5 days after percutaneous coronary intervention. RESULTS Patients were divided into the MVD group (76/130, 58.5%) and non-MVD group (54/130, 41.5%). Patients with MVD had higher cQFR-fQFR value (0.080 ± 0.058 vs. 0.038 ± 0.039, p < .001) and lower modeled HFV (0.096 ± 0.044 vs. 0.144 ± 0.041 m/s, p < .001). Receiver operator characteristic curve analysis revealed that both the cQFR-fQFR value (area under the curve, AUC = 0.716, p < .001) and modeled HFV (AUC = 0.805, p < .001) had high specificity and positive predictive value to predict MVD. In multivariable logistic analysis, cQFR-fQFR was identified as an independent predictor of MVD (odds ratio = 9.800, p < .001). CONCLUSIONS This proof-of-concept study suggested that QFR computation may be a useful tool to predict MVD after STEMI (Trial Registration:NCT03780335).
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Affiliation(s)
- Xincheng Sheng
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhiqing Qiao
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Heng Ge
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jiateng Sun
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jie He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zheng Li
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Song Ding
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Ding D, Yang J, Westra J, Chen Y, Chang Y, Sejr-Hansen M, Zhang S, Christiansen EH, Holm NR, Xu B, Tu S. Accuracy of 3-dimensional and 2-dimensional quantitative coronary angiography for predicting physiological significance of coronary stenosis: a FAVOR II substudy. Cardiovasc Diagn Ther 2019; 9:481-491. [PMID: 31737519 DOI: 10.21037/cdt.2019.09.07] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Three-dimensional quantitative coronary angiography (3D-QCA) enables reconstruction of a coronary artery in 3D from two angiographic image projections. This study compared the diagnostic accuracy of 3D-QCA vs. 2-dimensional (2D) QCA in predicting physiologically significant coronary stenosis, using fractional flow reserve (FFR) as the reference standard. Methods All interrogated vessels in the FAVOR II China study and the FAVOR II Europe-Japan study were assessed by 2D-QCA and 3D-QCA according to standard operating procedures in core laboratories. QCA analysts were blinded to the corresponding FFR values. Results A total of 645 vessels from 576 patients with 3D-QCA, 2D-QCA, and FFR were analyzed. Using the conventional cut-off value of 50% for percent diameter stenosis (DS%), 3D-QCA was more accurate in predicting FFR ≤0.80 than 2D-QCA [accuracy 74.0% (95% CI: 69.9-77.7%) vs. 64.9% (95% CI: 61.3-68.7%), difference: 9.1%, P<0.001]. Sensitivity was higher by 3D-QCA compared with 2D-QCA [69.1% (95% CI: 63.0-75.1%) vs. 47.1% (95% CI: 40.5-53.6%), difference: 22.0%, P<0.001] and specificity was similar [76.5% (95% CI: 72.5-80.6%) vs. 74.4% (95% CI: 70.2-78.6%), difference: 2.1%, P=0.40]. Area under the receiver operating characteristic curve was significantly higher for 3D-QCA than for 2D-QCA [0.81 (95% CI: 0.77-0.84) vs. 0.66 (95% CI: 0.62-0.71), P<0.001]. Conclusions 3D-QCA demonstrated better diagnostic performance in predicting physiologically significant coronary stenosis compared with 2D-QCA, when FFR was used as the reference standard.
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Affiliation(s)
- Daixin Ding
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Junqing Yang
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangzhou 510055, China
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Yundai Chen
- Department of Cardiology, PLA General Hospital, Beijing 100853, China
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | | | - Su Zhang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
| | | | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, China.,Shanghai Med-X Engineering Research Center, Shanghai Jiao Tong University, Shanghai 200030, China
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Yu W, Huang J, Jia D, Chen S, Raffel OC, Ding D, Tian F, Kan J, Zhang S, Yan F, Chen Y, Bezerra HG, Wijns W, Tu S. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity. EUROINTERVENTION 2019; 15:189-197. [PMID: 31147309 DOI: 10.4244/eij-d-19-00182] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS A novel method for computation of fractional flow reserve (FFR) from optical coherence tomography (OCT) was developed recently. This study aimed to evaluate the diagnostic accuracy of a new OCT-based FFR (OFR) computational approach, using wire-based FFR as the reference standard. METHODS AND RESULTS Patients who underwent both OCT and FFR prior to intervention were analysed. The lumen of the interrogated vessel and the ostia of the side branches were automatically delineated and used to compute OFR. Bifurcation fractal laws were applied to correct the change in reference lumen size due to the step-down phenomenon. OFR was compared with FFR, both using a cut-off value of 0.80 to define ischaemia. Computational analysis was performed in 125 vessels from 118 patients. Average FFR was 0.80±0.09. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for OFR to identify FFR ≤0.80 was 90% (95% CI: 84-95), 87% (95% CI: 77-94), 92% (95% CI: 82-97), 92% (95% CI: 82-97), and 88% (95% CI: 77-95), respectively. The AUC was higher for OFR than minimal lumen area (0.93 [95% CI: 0.87-0.97] versus 0.80 [95% CI: 0.72-0.86], p=0.002). Average OFR analysis time was 55±23 seconds for each OCT pullback. Intra- and inter-observer variability in OFR analysis was 0.00±0.02 and 0.00±0.03, respectively. CONCLUSIONS OFR is a novel and fast method allowing assessment of flow-limiting coronary stenosis without pressure wire and induced hyperaemia. The good diagnostic accuracy and low observer variability bear the potential of improved integration of intracoronary imaging and physiological assessment.
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Affiliation(s)
- Wei Yu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
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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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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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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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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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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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Collet C, Onuma Y, Cavalcante R, Grundeken M, Généreux P, Popma J, Costa R, Stankovic G, Tu S, Reiber JHC, Aben JP, Lassen JF, Louvard Y, Lansky A, Serruys PW. Quantitative angiography methods for bifurcation lesions: a consensus statement update from the European Bifurcation Club. EUROINTERVENTION 2017; 13:115-123. [PMID: 28067200 DOI: 10.4244/eij-d-16-00932] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Bifurcation lesions represent one of the most challenging lesion subsets in interventional cardiology. The European Bifurcation Club (EBC) is an academic consortium whose goal has been to assess and recommend the appropriate strategies to manage bifurcation lesions. The quantitative coronary angiography (QCA) methods for the evaluation of bifurcation lesions have been subject to extensive research. Single-vessel QCA has been shown to be inaccurate for the assessment of bifurcation lesion dimensions. For this reason, dedicated bifurcation software has been developed and validated. These software packages apply the principles of fractal geometry to address the "step-down" in the bifurcation and to estimate vessel diameter accurately. This consensus update provides recommendations on the QCA analysis and reporting of bifurcation lesions based on the most recent scientific evidence from in vitro and in vivo studies and delineates future advances in the field of QCA dedicated bifurcation analysis.
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Affiliation(s)
- Carlos Collet
- Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Chu M, Dai N, Yang J, Westra J, Tu S. A systematic review of imaging anatomy in predicting functional significance of coronary stenoses determined by fractional flow reserve. Int J Cardiovasc Imaging 2017; 33:975-990. [PMID: 28265791 DOI: 10.1007/s10554-017-1085-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/28/2017] [Indexed: 01/06/2023]
Abstract
Fractional flow reserve (FFR) is the current gold standard to assess the physiological significance of coronary stenoses. With the development of coronary imaging techniques, several anatomic parameters have been investigated in vivo and their associations with FFR have been studied. The aim of this review is to summarize the accuracy of anatomic parameters derived by the present coronary imaging techniques including invasive coronary angiography, coronary computed tomography angiography, intravascular ultrasound and optical coherence tomography, in predicting a significant FFR. The impact of patient characteristics, lesion locations, variability of FFR and imaging resolution on the predictive ability are discussed.
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Affiliation(s)
- Miao Chu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China
| | - Neng Dai
- Cardiovascular Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junqing Yang
- The 3rd Division of Cardiology, Department of Cardiology, Guangdong General Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, No.106, 2nd Zhongshan Road, Yuexiu district, Guangzhou, Guangdong, 510080, China.
| | - Jelmer Westra
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, No. 1954, Hua Shan Road, Shanghai, 200030, China.
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Anatomic Myocardial Volume Index by CT Versus Physiological Index by FFR Angiography Between the Main Vessel and Side Branch. JACC Cardiovasc Interv 2017; 10:582-584. [DOI: 10.1016/j.jcin.2017.01.002] [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: 12/12/2016] [Revised: 12/28/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
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Achenbach S, Rudolph T, Rieber J, Eggebrecht H, Richardt G, Schmitz T, Werner N, Boenner F, Möllmann H. Performing and Interpreting Fractional Flow Reserve Measurements in Clinical Practice: An Expert Consensus Document. Interv Cardiol 2017; 12:97-109. [PMID: 29588737 DOI: 10.15420/icr.2017:13:2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Fractional flow reserve (FFR) measurements can determine the haemodynamic relevance of coronary artery stenoses. Current guidelines recommend their use in lesions in the absence of non-invasive proof of ischaemia. The prognostic impact of FFR has been evaluated in randomised trials, and it has been shown that revascularisation can be safely deferred if FFR is >0.80, while revascularisation of stenoses with FFR values ≤0.80 results in significantly lower event rates compared to medical treatment. Left main stenoses, aorto-ostial lesions, as well as patients with left ventricular hypertrophy and severely-impaired ejection fraction, have been excluded from large, randomised trials. While FFR measurements are relatively straightforward to perform, uncertainty about procedural logistics, as well as data acquisition and interpretation in specific situations, could explain why they are not widely used in clinical practice. We summarise the clinical data in support of FFR measurements, and provide recommendations for performing and interpreting the procedure.
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Affiliation(s)
- Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander University (FAU) Erlangen-Nuremberg, Germany
| | - Tanja Rudolph
- Department of Internal Medicine 3, University Hospital, Cologne, Germany
| | - Johannes Rieber
- Heart Centre, Municipal Hospitals of Munich, Munich, Germany
| | | | | | | | - Nikos Werner
- Department of Internal Medicine 2, University Hospital, Bonn, Germany
| | - Florian Boenner
- Department of Internal Medicine, University Hospital, Düsseldorf, Germany
| | - Helge Möllmann
- Department of Cardiology, St Johannes Hospital, Dortmund, Germany
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van Houwelingen KG, van der Heijden LC, Lam MK, Kok MM, Löwik MM, Louwerenburg JW, Linssen GCM, IJzerman MJ, Doggen CJM, von Birgelen C. Long-term outcome and chest pain in patients with true versus non-true bifurcation lesions treated with second-generation drug-eluting stents in the TWENTE trial. Heart Vessels 2016; 31:1731-1739. [PMID: 26747438 PMCID: PMC5085988 DOI: 10.1007/s00380-015-0786-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 12/16/2015] [Indexed: 12/31/2022]
Abstract
The objective of this study is to assess 3-year clinical outcome of patients with true bifurcation lesions (TBLs) versus non-true bifurcation lesions (non-TBLs) following treatment with second-generation drug-eluting stents (DES). TBLs are characterized by the obstruction of both main vessel and side-branch. Limited data are available on long-term clinical outcome following TBL treatment with newer-generation DES. We performed an explorative sub-study of the randomized TWENTE trial among 287 patients who had bifurcated target lesions with side-branches ≥2.0 mm. Patients were categorized into TBL (Medina classes: 1.1.1; 1.0.1; 0.1.1) versus non-TBL to compare long-term clinical outcome. A total of 116 (40.4 %) patients had TBL, while 171 (59.6 %) had non-TBL only. Target-lesion revascularization rates were similar (3.5 vs. 3.5 %; p = 1.0), and definite-or-probable stent thrombosis rates were low (both <1.0 %). The target-vessel myocardial infarction (MI) rate was 11.3 versus 5.3 % (p = 0.06), mostly driven by (periprocedural) MI ≤48 h from PCI. All-cause mortality and cardiac death rates were 8.7 versus 3.5 % (p = 0.06) and 3.5 versus 1.2 % (p = 0.22), respectively. The 3-year major adverse cardiac event rate for patients with TBL versus non-TBL was 20.0 versus 11.7 % (p = 0.05). At 1-, 2-, and 3-year follow-up, 6.5, 13.0, and 11.0 % of patients reported chest pain at less than or equal moderate physical effort, respectively, without any between-group difference. Patients treated with second-generation DES for TBL had somewhat higher adverse event rates than patients with non-TBL, but dissimilarities did not reach statistical significance. Up to 3-year follow-up, the vast majority of patients of both groups remained free from chest pain.
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Affiliation(s)
- K Gert van Houwelingen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Liefke C van der Heijden
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Ming Kai Lam
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marlies M Kok
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Marije M Löwik
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - J W Louwerenburg
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands
| | - Gerard C M Linssen
- Department of Cardiology, Ziekenhuisgroep Twente, Almelo and Hengelo, The Netherlands
| | - Maarten J IJzerman
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carine J M Doggen
- Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands. .,Health Technology and Services Research, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.
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Fraktionelle Flussreserve in der Diagnostik der koronaren Herzerkrankung. DER KARDIOLOGE 2016. [DOI: 10.1007/s12181-016-0049-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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