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Zhu T, Li D, Qiao J, Li Q, Xu Y, Ge B, Xia L. Accuracy of subtraction fractional flow reserve with computed tomography in identifying early revascularization in patients with coronary artery disease. SCAND CARDIOVASC J 2024; 58:2373082. [PMID: 38962961 DOI: 10.1080/14017431.2024.2373082] [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: 11/28/2023] [Accepted: 06/22/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES The diagnostic performance of fractional flow reserve with computed tomography (FFR-CT) is affected by the presence of calcified plaque. Subtraction can remove the influence of calcification in coronary computed tomography angiography (CCTA) to increase confidence in the diagnosis of coronary artery stenosis. Our purpose is to investigate the accuracy of post-subtraction FFR-CT in predicting early revascularization. DESIGN Based on CCTA data of 237 vessels from 79 patients with coronary artery disease, subtraction CCTA images were obtained at a local post-processing workstation, and the conventional and post-subtraction FFR-CT measurements and the difference in proximal and distal FFR-CT values of the narrowest segment of the vessel (ΔFFR-CT) were analyzed for their accuracy in predicting early coronary artery hemodynamic reconstruction. RESULTS With FFR-CT ≤ 0.8 as the criterion, the accuracy of conventional and post-subtraction FFR-CT measurements in predicting early revascularization was 73.4% and 77.2% at the patient level, and 64.6% and 72.2% at the vessel level, respectively. The specificity of post-subtraction FFR-CT measurements was significantly higher than that of conventional FFR-CT at both the patient and vessel levels (P of 0.013 and 0.015, respectively). At the vessel level, the area under the curve of receiver operating characteristic was 0.712 and 0.797 for conventional and post-subtraction ΔFFR-CT, respectively, showing a difference (P = 0.047), with optimal cutoff values of 0.07 and 0.11, respectively. CONCLUSION The post-subtraction FFR-CT measurements enhance the specificity in predicting early revascularization. The post-subtraction ΔFFR-CT value of the stenosis segment > 0.11 may be an important indicator for early revascularization.
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Affiliation(s)
- Tingting Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Defu Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Fuyong People's Hospital of Shenzhen Baoan, Shenzhen, China
| | - Jinhan Qiao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Qian Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinghao Xu
- Canon Medical Systems (China) Co. LTD, Beijing, China
| | - Bing Ge
- Canon Medical Systems (China) Co. LTD, Beijing, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Liu Z, Liu Y, Liu J, Sun H, Liu J, Hou C, Wang L, Li B. Noninvasive and fast method of calculation for instantaneous wave-free ratio based on haemodynamics and deep learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108355. [PMID: 39067137 DOI: 10.1016/j.cmpb.2024.108355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 07/21/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND AND OBJECTIVES Instantaneous wave-free ratio (iFR) is a new invasive indicator of myocardial ischaemia, and its diagnostic performance is as good as the "gold standard" of myocardial ischaemia diagnosis: fractional flow reserve (FFR). iFR can be approximated by iFRCT, which is calculated based on noninvasive coronary CT angiography (CTA) images and computational fluid dynamics (CFD). However, the existing methods for calculating iFRCT fail to accurately simulate the resting state of the coronary artery, resulting in low computational accuracy. Furthermore, the use of CFD technology limits its computational efficiency, making it difficult to meet clinical application needs. The role of coronary microcirculatory resistance compensation suggests that microcirculatory resistance can be adaptively reduced to compensate for increases in coronary stenotic resistance, thereby maintaining stable myocardial perfusion in the resting state. It is therefore necessary to consider this compensation mechanism to establish a high-fidelity microcirculation resistance model in the resting state in line with human physiology, and so to achieve accurate calculation of iFRCT. METHODS In this study we successfully collected clinical data, such as FFR, in 205 stenotic vessels from 186 patients with coronary heart disease. A neural network model was established to predict coronary artery stenosis resistance. Based on the compensation mechanism of coronary microcirculation resistance, an iterative solution algorithm for microcirculation resistance in the resting state was developed. Combining the two methods, a simplified single-branch model combining coronary stenosis and microcirculation resistance was established, and the noninvasive and rapid numerical calculation of iFRCT was performed. RESULTS The results showed that the mean squared error (MSE) between the pressure drop predicted by the neural network value for the coronary artery stenosis model and the ground truth in the test set was 0.053 %, and correlation analysis proved that there was a good correlation between them (r = 0.99, p < 0.001). With reference to clinical diagnosis of myocardial ischaemia (using FFR as the gold standard), the diagnostic accuracy of the iFRCT calculation model for the 205 cases was 88.29 % (r = 0.71, p < 0.001), and the total calculation time was < 8 s. CONCLUSIONS The results of this study demonstrate the utility of a simplified single-branch model in an iFRCT calculation method based on haemodynamics and deep learning, which is important for noninvasive and rapid diagnosis of myocardial ischaemia.
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Affiliation(s)
- Zining Liu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Jincheng Liu
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Hao Sun
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China
| | - Jian Liu
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Chang Hou
- Cardiovascular department, Peking University People's Hospital, Beijing, China
| | - Lihua Wang
- Radiology department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Bao Li
- Department of Biomedical Engineering, College of Chemistry and Life Science, Beijing University of Technology, Beijing, China.
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Sun Q, Zhang J, Wang W, Qi Y, Lyu J, Zhang X, Li T, Lou X. Predictors of discordance between CT-derived fractional flow reserve (CT-FFR) and △CT-FFR in deep coronary myocardial bridging. Clin Imaging 2024; 114:110264. [PMID: 39216275 DOI: 10.1016/j.clinimag.2024.110264] [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: 07/05/2024] [Revised: 08/04/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To compare the performance between CT-derived fractional flow reserve (CT-FFR) and ΔCT-FFR measurements in patients with deep myocardial bridging (MB) along the left anterior descending artery, and explore the potential predictors of discordance. METHODS 175 patients with deep MB who underwent coronary computed tomography angiography (CCTA) and CT-FFR assessment were included. Clinical, anatomical and atherosclerotic variables were compared between patients with concordant and discordant CT-FFR and ΔCT-FFR. RESULTS 30.9 % patients were discordantly classified, in which 94.4 % patients were classified as CT-FFR+/△CT-FFR-. The discordant group showed significantly higher upstream stenosis degree, distance from MB to the aorta, △CT-FFR (P 0.007, 0.009 and 0.002, respectively), and lower CT-FFR (P < 0.001). In multivariate analysis, upstream stenosis degree (P 0.023, OR 1.628, 95 % CI: 1.068-2.481) and distance from MB to the aorta (P 0.001, OR 1.04, 95 % CI: 1.016-1.064) were independent predictors for discordance between CT-FFR and ΔCT-FFR. CONCLUSION The discordance between CT-FFR and ΔCT-FFR measurements underscores the challenges in clinical decision-making, necessitating tailored approaches for MB evaluation.
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Affiliation(s)
- Qingbo Sun
- Department of Radiology, Huanghua Municipal People's Hospital, 262 Xinhua Road, Changzhou, Hebei 061100, China
| | - Jing Zhang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Wanbing Wang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Yeqing Qi
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Jinhao Lyu
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Xinghua Zhang
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China.
| | - Tao Li
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
| | - Xin Lou
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853, China
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Žuža I, Nadarević T, Jakljević T, Bartolović N, Kovačić S. The Effect of Severe Coronary Calcification on Diagnostic Performance of Computed Tomography-Derived Fractional Flow Reserve Analyses in People with Coronary Artery Disease. Diagnostics (Basel) 2024; 14:1738. [PMID: 39202227 PMCID: PMC11353250 DOI: 10.3390/diagnostics14161738] [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: 06/25/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
BACKGROUND Negative CCTA can effectively exclude significant CAD, eliminating the need for further noninvasive or invasive testing. However, in the presence of severe CAD, the accuracy declines, thus necessitating additional testing. The aim of our study was to evaluate the diagnostic performance of noninvasive cFFR derived from CCTA, compared to ICA in detecting hemodynamically significant stenoses in participants with high CAC scores (>400). METHODS This study included 37 participants suspected of having CAD who underwent CCTA and ICA. CAC was calculated and cFFR analyses were performed using an on-site machine learning-based algorithm. Diagnostic accuracy parameters of CCTA and cFFR were calculated on a per-vessel level. RESULTS The median total CAC score was 870, with an IQR of 642-1370. Regarding CCTA, sensitivity and specificity for RCA were 60% and 67% with an AUC of 0.639; a LAD of 87% and 50% with an AUC of 0.688; an LCX of 33% and 90% with an AUC of 0.617, respectively. Regarding cFFR, sensitivity and specificity for RCA were 60% and 61% with an AUC of 0.606; a LAD of 75% and 54% with an AUC of 0.647; an LCX of 50% and 77% with an AUC of 0.647. No significant differences between AUCs of coronary CTA and cFFR for each vessel were found. CONCLUSIONS Our results showed poor diagnostic accuracy of CCTA and cFFR in determining significant ischemia-related lesions in participants with high CAC scores when compared to ICA. Based on our results and study limitations we cannot exclude cFFR as a method for determining significant stenoses in people with high CAC. A key issue is accurate and detailed lumen segmentation based on good-quality CCTA images.
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Affiliation(s)
- Iva Žuža
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
| | - Tin Nadarević
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Tomislav Jakljević
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
- Clinic for Heart and Vessel Diseases, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Nina Bartolović
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Slavica Kovačić
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia; (T.N.); (N.B.); (S.K.)
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
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Chen L, Dai L, Xu J, Duan L, Hou X, Zhang L, Song L, Zhao F, Jiang Y. Chinese herbal compound preparation Qing-Xin-Jie-Yu granules for intermediate coronary lesions in patients with stable coronary artery disease: Study protocol for a multicenter, randomized, double-blind, placebo-controlled trial. PLoS One 2024; 19:e0307074. [PMID: 39012918 PMCID: PMC11251585 DOI: 10.1371/journal.pone.0307074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/24/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Despite the available secondary preventive treatments, the management of stable coronary artery disease (SCAD) remains challenging. Intermediate coronary lesion (ICL), defined as luminal stenosis between 50% and 70%, is a key stage of SCAD. However, existing therapeutic strategies are limitated in delaying plaque progression and associated with various adverse effects and economic burdens. Qing-Xin-Jie-Yu Granules (QXJYG) with proven anti-platelet, anti-inflammatory, and lipid-lowering effects may compensate for the drawbacks of current treatments and can be tested as a complementary therapy. Therefore, this study aims to investigate the efficacy and safety of QXJYG in treating ICL, with a particular focus on its impact on myocardial ischemia and plaque progression. MATERIALS AND METHODS This is a multicenter, randomized, double-blind, placebo-controlled trial. A total of 120 participants with ICL will be randomly assigned to two groups in a 1:1 ratio. In addition to basic medications, the intervention group will receive QXJYG, while the control group will receive a placebo for over 6 months, followed by a 12-month follow-up. The primary efficacy outcome is computed tomography-derived fractional flow reserve. The secondary outcomes include the degree of coronary stenosis, coronary artery calcification score, Gensini score, Seattle Angina Questionnaire score, high-sensitivity C-reactive protein, matrix metalloproteinase-9, blood lipids, and carotid artery ultrasound parameters. Major adverse cardiovascular events are recorded as endpoints. The safety outcomes include composite events of bleeding, laboratory test results, and adverse events. Clinical visits are scheduled at baseline, every 2 months during the treatment, and after a 12-month follow-up. DISCUSSION This trial is anticipated to yield reliable results to verify the efficacy and safety of QXJYG in the treatment of ICL, which will provide novel insights to help address the prevailing therapeutic dilemma of ICL, thereby facilitating for the management of SCAD. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2200059262. Registered on April 27, 2022.
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Affiliation(s)
- Luying Chen
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lulu Dai
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiawei Xu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lian Duan
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaoxia Hou
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lu Zhang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Libo Song
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fangfang Zhao
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Chinese Journal of Integrated Traditional and Western Medicine Press, Beijing, China
| | - Yuerong Jiang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Wang Z, Tang C, Zuo R, Zhou A, Xu W, Zhong J, Xu Z, Zhang L. Pre-PCI CT-FFR Predicts Target Vessel Failure After Stent Implantation. J Thorac Imaging 2024; 39:232-240. [PMID: 38800956 DOI: 10.1097/rti.0000000000000791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To investigate the predictive value of coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) before percutaneous coronary intervention (PCI) to predict target vessel failure (TVF) after stent implantation. METHODS This retrospective study included 429 patients (429 vessels) who underwent PCI and stent implantation after CCTA within 3 months. All patients underwent coronary stent implantation between January 2012 and December 2019. A dedicated workstation (Syngo Via, Siemens) was used to analyze and measure the CT-FFR value. The cut-off values of pre-PCI CT-FFR for predicting TVF were defined as 0.80 and the value using the log-rank maximization method, respectively. The primary outcome was TVF, defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization (TVR), which was a secondary outcome. RESULTS During a median 64.0 months follow-up, the cumulative incidence of TVF was 7.9% (34/429). The cutoff value of pre-PCI CT-FFR based on the log-rank maximization method was 0.74, which was the independent predictor for TVF [hazard ratio (HR): 2.61 (95% CI: 1.13, 6.02); P =0.024] and TVR [HR: 3.63 (95%CI: 1.25, 10.51); P =0.018]. Compared with the clinical risk factor model, pre-PCI CT-FFR significantly improved the reclassification ability for TVF [net reclassification improvement (NRI), 0.424, P <0.001; integrative discrimination index (IDI), 0.011, P =0.022]. Adding stent information to the prediction model resulted in an improvement in reclassification for the TVF (C statistics: 0.711, P =0.001; NRI: 0.494, P <0.001; IDI: 0.020, P =0.028). CONCLUSIONS Pre-PCI CT-FFR ≤0.74 was an independent predictor for TVF or TVR, and integration of clinical, pre-PCI CT-FFR, and stent information models can provide a better risk stratification model in patients with stent implantation.
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Affiliation(s)
- Zewen Wang
- Department of Radiology, Jinling Hospital, Nanjing Medical University
| | - Chunxiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Rui Zuo
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Aiming Zhou
- Department of Radiology, Hai'an Hospital of Traditional Chinese Medicine, Nantong, Jiangsu
| | - Wei Xu
- Department of Radiology, Jinling Hospital, Nanjing Medical University
| | - Jian Zhong
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
| | - Zhihan Xu
- CT Collaboration, Siemens Healthineers, Shanghai, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing
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Zhang L, Dong YF, Chen Y, Li XG, Wang YH, Wang Y, Ge ZT, Wang X, Cai S, Yang X, Zhu QL, Li JC. Impact of Microbubble Degradation and Flow Velocity on Subharmonic-aided Pressure Estimation (SHAPE): An Experimental Investigation. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1020-1027. [PMID: 38594125 DOI: 10.1016/j.ultrasmedbio.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/12/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This study aimed to investigate the impact of microbubble degradation and flow velocity on Sub-Harmonic Aided Pressure Estimation (SHAPE), and to explore the correlation between subharmonic amplitude and pressure as a single factor. METHODS We develop an open-loop vascular phantom platform system and utilize a commercial ultrasound machine and microbubbles for subharmonic imaging. Subharmonic amplitude was measured continuously at constant pressure and flow velocity to assess the impact of microbubble degradation. Flow velocity was varied within a range of 4-14 cm/s at constant pressure to investigate its relationship to subharmonic amplitude. Furthermore, pressure was varied within a range of 10-110 mm Hg at constant flow velocity to assess its isolated effect on subharmonic amplitude. RESULTS Under constant pressure and flow velocity, subharmonic amplitude exhibited a continuous decrease at an average rate of 0.221 dB/min, signifying ongoing microbubble degradation during the experimental procedures. Subharmonic amplitude demonstrated a positive correlation with flow velocity, with a variation ratio of 0.423 dB/(cm/s). Under controlled conditions of microbubble degradation and flow velocity, a strong negative linear correlation was observed between pressure and subharmonic amplitude across different Mechanical Index (MI) settings (all R2 > 0.90). The sensitivity of SHAPE was determined to be 0.025 dB/mmHg at an MI of 0.04. CONCLUSION The assessment of SHAPE sensitivity is affected by microbubble degradation and flow velocity. Excluding the aforementioned influencing factors, a strong linear negative correlation between pressure and subharmonic amplitude was still evident, albeit with a sensitivity coefficient lower than previously reported values.
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Affiliation(s)
- Li Zhang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi-Fan Dong
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yao Chen
- Department of Ultrasound, GE Healthcare Medical System (China), Shanghai, China
| | - Xiao-Gang Li
- Biobank Facility, National Infrastructures for Translational Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ya-Hong Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhi-Tong Ge
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xin Wang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Sheng Cai
- Department of Health Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qing-Li Zhu
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jian-Chu Li
- Department of Diagnostic Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Hwang D, Park SH, Nam CW, Doh JH, Kim HK, Kim Y, Chun EJ, Koo BK. Diagnostic Performance of On-Site Automatic Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve. Korean Circ J 2024; 54:382-394. [PMID: 38767442 PMCID: PMC11252635 DOI: 10.4070/kcj.2023.0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 02/05/2024] [Accepted: 03/05/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Fractional flow reserve (FFR) is an invasive standard method to identify ischemia-causing coronary artery disease (CAD). With the advancement of technology, FFR can be noninvasively computed from coronary computed tomography angiography (CCTA). Recently, a novel simpler method has been developed to calculate on-site CCTA-derived FFR (CT-FFR) with a commercially available workstation. METHODS A total of 319 CAD patients who underwent CCTA, invasive coronary angiography, and FFR measurement were included. The primary outcome was the accuracy of CT-FFR for defining myocardial ischemia evaluated with an invasive FFR as a reference. The presence of ischemia was defined as FFR ≤0.80. Anatomical obstructive stenosis was defined as diameter stenosis on CCTA ≥50%, and the diagnostic performance of CT-FFR and CCTA stenosis for ischemia was compared. RESULTS Among participants (mean age 64.7±9.4 years, male 77.7%), mean FFR was 0.82±0.10, and 126 (39.5%) patients had an invasive FFR value of ≤0.80. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of CT-FFR were 80.6% (95% confidence interval [CI], 80.5-80.7%), 88.1% (95% CI, 82.4-93.7%), 75.6% (95% CI, 69.6-81.7%), 70.3% (95% CI, 63.1-77.4%), and 90.7% (95% CI, 86.2-95.2%), respectively. CT-FFR had higher diagnostic accuracy (80.6% vs. 59.1%, p<0.001) and discriminant ability (area under the curve from receiver operating characteristic curve 0.86 vs. 0.64, p<0.001), compared with anatomical obstructive stenosis on CCTA. CONCLUSIONS This novel CT-FFR obtained from an on-site workstation demonstrated clinically acceptable diagnostic performance and provided better diagnostic accuracy and discriminant ability for identifying hemodynamically significant lesions than CCTA alone.
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Affiliation(s)
- Doyeon Hwang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Sang-Hyeon Park
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Chang-Wook Nam
- Department of Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Hyun Kuk Kim
- Chosun University Hospital, University of Chosun College of Medicine, Gwangju, Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea
| | - Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, Korea.
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Nozaki YO, Fujimoto S, Takahashi D, Kudo A, Kawaguchi YO, Sato H, Kudo H, Takamura K, Hiki M, Dohi T, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Additional prognostic impact of plaque characterization with on-site CT-derived fractional flow reserve in coronary CT angiography. J Cardiol 2024:S0914-5087(24)00098-4. [PMID: 38876399 DOI: 10.1016/j.jjcc.2024.05.009] [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: 11/12/2023] [Revised: 05/17/2024] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND On-site computed tomography-derived fractional flow reserve (CT-FFR) is a feasible method for examining lesion-specific ischemia, and plaque analysis of coronary CT angiography (CCTA) is useful for predicting future cardiac events. However, their utility and association on a per-vessel level remain unclear. METHODS We analyzed vessels showing 50-90 % stenosis on CCTA where planned revascularization was not performed after CCTA within 90 days. Relevant features, including CT-FFR and the plaque burden [necrotic core to the total plaque volume (% necrotic core), and non-calcified plaque (NCP) to vessel volume (% NCP)] using a novel algorithm for analyzing plaque to predict vessel-oriented composite outcomes (VOCO), including cardiac death, non-fatal myocardial infarction, and unplanned vessel-related revascularization, were assessed. RESULTS In 256 patients (68.7 ± 9.4 years; 73.8 % male) with 354 vessels (10.5 % CT-FFR ≤ 0.80), VOCO occurred in 24 vessels (6.8 %) during a median follow-up of 3.6 years. Multivariable Cox analysis revealed CT-FFR ≤ 0.80 had the pronounced impact on VOCO, and moreover, higher % necrotic core and % NCP were independently associated with VOCO [adjusted hazard ratio 3.43 (95 % confidence interval 1.42-8.29) and 4.05 (1.19-13.71), respectively], especially for vessels with CT-FFR > 0.80. CONCLUSIONS In vessels without planned revascularization, per-vessel CT-FFR ≤ 0.80 was the notable predictor of future cardiac events. Additionally, necrotic core volume and NCP were identified as independent predictors along with CT-FFR.
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Affiliation(s)
- Yui O Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Daigo Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Ayako Kudo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko O Kawaguchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hideyuki Sato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Radiological Technology, Juntendo University Hospital, Tokyo, Japan
| | - Hikaru Kudo
- Department of Radiological Technology, Juntendo University Hospital, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobuo Tomizawa
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kanako K Kumamaru
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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10
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Guo B, Jiang M, Guo X, Tang C, Zhong J, Lu M, Liu C, Zhang X, Qiao H, Zhou F, Xu P, Xue Y, Zheng M, Hou Y, Wang Y, Zhang J, Zhang B, Zhang D, Xu L, Hu X, Zhou C, Li J, Yang Z, Mao X, Lu G, Zhang L. Diagnostic and prognostic performance of artificial intelligence-based fully-automated on-site CT-FFR in patients with CAD. Sci Bull (Beijing) 2024; 69:1472-1485. [PMID: 38637226 DOI: 10.1016/j.scib.2024.03.053] [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] [Received: 08/21/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 04/20/2024]
Abstract
Currently, clinically available coronary CT angiography (CCTA) derived fractional flow reserve (CT-FFR) is time-consuming and complex. We propose a novel artificial intelligence-based fully-automated, on-site CT-FFR technology, which combines the automated coronary plaque segmentation and luminal extraction model with reduced order 3 dimentional (3D) computational fluid dynamics. A total of 463 consecutive patients with 600 vessels from the updated China CT-FFR study in Cohort 1 undergoing both CCTA and invasive fractional flow reserve (FFR) within 90 d were collected for diagnostic performance evaluation. For Cohort 2, a total of 901 chronic coronary syndromes patients with index CT-FFR and clinical outcomes at 3-year follow-up were retrospectively analyzed. In Cohort 3, the association between index CT-FFR from triple-rule-out CTA and major adverse cardiac events in patients with acute chest pain from the emergency department was further evaluated. The diagnostic accuracy of this CT-FFR in Cohort 1 was 0.82 with an area under the curve of 0.82 on a per-patient level. Compared with the manually dependent CT-FFR techniques, the operation time of this technique was substantially shortened by 3 times and the number of clicks from about 60 to 1. This CT-FFR technique has a highly successful (> 99%) calculation rate and also provides superior prediction value for major adverse cardiac events than CCTA alone both in patients with chronic coronary syndromes and acute chest pain. Thus, the novel artificial intelligence-based fully automated, on-site CT-FFR technique can function as an objective and convenient tool for coronary stenosis functional evaluation in the real-world clinical setting.
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Affiliation(s)
- Bangjun Guo
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Mengchun Jiang
- Department of Radiology, Affiliated Hospital of Jining Medical University, Jining 272007, China
| | - Xiang Guo
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Chunxiang Tang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Jian Zhong
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Mengjie Lu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Chunyu Liu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Xiaolei Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Hongyan Qiao
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Pengpeng Xu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Yi Xue
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an 733399, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Yining Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100005, China
| | - Jiayin Zhang
- Institute of Diagnostic and Interventional Radiology, and Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200235, China
| | - Bo Zhang
- Department of Radiology, Jiangsu Taizhou People's Hospital, Taizhou 225399, China
| | - Daimin Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210012, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiuhua Hu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310020, China
| | - Changsheng Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Jianhua Li
- Department of Cardiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China
| | - Zhiwen Yang
- Shukun (Beijing) Network Technology Co., Ltd., Beijing 102200, China
| | - Xinsheng Mao
- Shukun (Beijing) Network Technology Co., Ltd., Beijing 102200, China
| | - Guangming Lu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China.
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210002, China.
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Hou C, Lu Y, Ma Y, Li Q, Liu C, Lu M, Cao C, Liu J. Investigation of the predictive value of a novel algorithm based on coronary CT angiography regarding fractional flow reserve and revascularization in patients with stable coronary artery disease. Heart Vessels 2024; 39:195-205. [PMID: 37897523 DOI: 10.1007/s00380-023-02324-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 09/28/2023] [Indexed: 10/30/2023]
Abstract
Fractional flow reserve (FFR) has been established as a gold standard for functional coronary ischemia. At present, the FFR can be calculated from coronary computed tomography angiography (CCTA) images (CT-FFR). Previous studies have suggested that CT-FFR outperforms CCTA and invasive coronary angiography (ICA) in determining hemodynamic significance of stenoses. Recently, a novel automatical algorithm of CT-FFR called RuiXin-FFR has been developed. The present study is designed to investigate the predictive value of this algorithm and its value in therapeutic decision making. The present study retrospectively included 166 patients with stable coronary artery disease (CAD) who underwent CCTA screening and diagnostic ICA examination at Peking University People's Hospital, in 73 of whom wire-derived FFR was also measured. CT-FFR analyses were performed with a dedicated software. All patients were followed up for at least 1 year. We validated the accuracy of RuiXin-FFR with invasive FFR as the standard of reference, and investigated the role of RuiXin-FFR in predicting treatment strategy and long-term prognosis. The mean age of the patients was 63.3 years with 63.9% male. The CT-FFR showed a moderate correlation with wire-derived FFR (r = 0.542, p < 0.0001) and diagnostic accuracy of 87.6% to predict myocardial ischemia (AUC: 0.839, 95% CI 0.728-0.950), which was significantly higher than CCTA and ICA. In the multivariate logistic regression analysis, CT-FFR ≤ 0.80 was an independent predictor of undergoing coronary revascularization (OR: 45.54, 95% CI 12.03-172.38, p < 0.0001), whereas CT-FFR > 0.80 was an independent predictor of non-obstructive CAD (OR: 14.67, 95% CI 5.42-39.72, p < 0.0001). Reserving ICA and revascularization for vessels with positive CT-FFR could have reduced the rate of ICA by 29.6%, lowered the rate of ICA in vessels without stenosis > 50% by 11.7%, and increased the rate of revascularization in patients receiving ICA by 21.2%. The average follow-up was 23.7 months, and major adverse cardiovascular events (MACE) occurred in 11 patients. The rate of MACE was significantly lower in patients with CT-FFR > 0.80. The new algorithm of CT-FFR can be used to predict the invasive FFR. The RuiXin-FFR can also provide useful information for the screening of patients in whom further ICA is indeed needed and prognosis evaluation.
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Affiliation(s)
- Chang Hou
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Yahui Lu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Yuliang Ma
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Qi Li
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Chuanfen Liu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Mingyu Lu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Chengfu Cao
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, China.
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People's Hospital, Beijing, China.
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12
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Wu X, Wang K, Li G, Wu J, Jiang J, Gao F, Zhu L, Xu Q, Wang X, Xu M, Chen H, Ma L, Han X, Luo N, Tu S, Wang J, Hu X. Diagnostic Performance of Angiography-Derived Quantitative Flow Ratio in Complex Coronary Lesions. Circ Cardiovasc Imaging 2024; 17:e016046. [PMID: 38502735 DOI: 10.1161/circimaging.123.016046] [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: 08/21/2023] [Accepted: 01/23/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Quantitative flow ratio derived from computed tomography angiography (CT-QFR) and invasive coronary angiography (Murray law-based quantitative flow ratio [μQFR]) are novel approaches enabling rapid computation of fractional flow reserve without the use of pressure guidewires and vasodilators. However, the feasibility and diagnostic performance of both CT-QFR and μQFR in evaluating complex coronary lesions remain unclear. METHODS Between September 2014 and September 2021, 240 patients with 30% to 90% coronary diameter stenosis who underwent both coronary computed tomography angiography and invasive coronary angiography with fractional flow reserve within 60 days were retrospectively enrolled. The diagnostic performance of CT-QFR and μQFR in detecting functional ischemia among all lesions, especially complex coronary lesions, was analyzed using fractional flow reserve as the reference standard. RESULTS CT-QFR and μQFR analyses were performed on 309 and 289 vessels, respectively. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for CT-QFR in all lesions at the per-vessel level were 91% (with a 95% CI of 84%-96%), 92% (95% CI, 88%-95%), 83% (95% CI, 75%-90%), 96% (95% CI, 93%-98%), and 92% (95% CI, 88%-95%), with values for μQFR of 90% (95% CI, 81%-95%), 97% (95% CI, 93%-99%), 92% (95% CI, 84%-97%), 96% (95% CI, 92%-98%), and 94% (95% CI, 91%-97%), respectively. Among bifurcation, tandem, and moderate-to-severe calcified lesions, the diagnostic values of CT-QFR and μQFR showed great correlation and agreement with those of invasive fractional flow reserve, achieving an area under the receiver operating characteristic curve exceeding 0.9 for each complex lesion at the vessel level. Furthermore, the accuracies of CT-QFR and μQFR in the gray zone were 85% and 84%, respectively. CONCLUSIONS Angiography-derived quantitative flow ratio (CT-QFR and μQFR) demonstrated remarkable diagnostic performance in complex coronary lesions, indicating its pivotal role in the management of patients with coronary artery disease.
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Affiliation(s)
- Xianpeng Wu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Kan Wang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Guohua Li
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Jie Wu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Department of Cardiology, Jinhua People's Hospital, Jinhua, China (J. Wu)
| | - Jun Jiang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Feng Gao
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Lingjun Zhu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Qiyuan Xu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Xinhong Wang
- Department of Radiology (X. Wang, M.X.), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Mengxi Xu
- Department of Radiology (X. Wang, M.X.), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hui Chen
- Department of Cardiology (H.C., L.M.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Longhui Ma
- Department of Cardiology (H.C., L.M.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xianjun Han
- Department of Radiology (X. Han, N.L.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Nan Luo
- Department of Radiology (X. Han, N.L.), Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (S.T.)
| | - Jian'an Wang
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
| | - Xinyang Hu
- Department of Cardiology (X. Wu, K.W., G.L., J. Wu, J.J., F.G., L.Z., Q.X., J. Wang, X. Hu), the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- State Key Laboratory of Transvascular Implantation Devices, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
- Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, China (X. Wu, K.W., G.L., J.J., F.G., L.Z., Q.X., J. Wang, X. Hu)
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13
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Yang S, Koo BK. Noninvasive Coronary Physiological Assessment Derived From Computed Tomography. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101304. [PMID: 39131222 PMCID: PMC11308392 DOI: 10.1016/j.jscai.2024.101304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 08/13/2024]
Abstract
Identifying functional significance using physiological indexes is a standard approach in decision-making for treatment strategies in patients with coronary artery disease. Recently, coronary computed tomography angiography-based physiological assessments, such as computed tomography perfusion and fractional flow reserve derived from coronary computed tomography angiography (FFR-CT), have emerged. These methods have provided incremental diagnostic values for ischemia-causing lesions over anatomical stenosis defined solely by coronary computed tomography angiography. Clinical data have demonstrated their prognostic value in the prediction of adverse cardiovascular events. Several randomized controlled studies have shown that clinical use of FFR-CT can reduce unnecessary invasive procedures compared to usual care. Recent studies have also expanded the role of FFR-CT in defining target lesions for revascularization by acquiring noninvasive lesion-specific hemodynamic indexes like ΔFFR-CT. This review encompasses the current evidence of the diagnostic and prognostic performance of computed tomography-based physiological assessment in defining ischemia-causing lesions and adverse cardiac events, its clinical impact on treatment decision-making, and implications for revascularization.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, South Korea
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul National University of College Medicine, Seoul, South Korea
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14
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Xu W, Ma J, Chen Y, Zhou F, Zhou C, Zhang LJ. Coronary chronic total occlusion on coronary CT angiography: what radiologists should know? Insights Imaging 2024; 15:55. [PMID: 38411752 PMCID: PMC10899151 DOI: 10.1186/s13244-024-01621-y] [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: 09/28/2023] [Accepted: 01/11/2024] [Indexed: 02/28/2024] Open
Abstract
Coronary chronic total occlusion (CTO) often occurs in patients with obstructive coronary artery disease, which remains one of the greatest challenges for interventional cardiologists. Coronary computed tomography angiography (CCTA) with its emerging post-processing techniques can provide a detailed assessment of CTO lesions before percutaneous coronary intervention (PCI), playing an important role in the clinical management of CTO PCI, from early diagnosis, pre-procedural outcome prediction, the crossing algorithm planning, intraprocedural guidance, and finally post-procedural assessment and follow-up. In addition, the feasibility of CT perfusion (CTP) in patients with CTO has been validated. Combined CCTA and CTP have the great potential to be the one-stop-shop imaging modality for assessing both anatomy and function of CTO lesions. This review aims to make radiologists understand the role of CCTA in the diagnosis and assessment of CTO lesions, thus assisting interventionalists in optimizing CTO PCI crossing strategies with the expertise of radiologists.Critical relevance statement The anatomical features of CTO on CCTA can reveal the complexity of CTO lesions and are associated with CTO PCI outcome, thus helping interventionalists optimize CTO PCI crossing strategies.Key points • CTO is the common lesion in invasive coronary angiography, and CTO PCI is technically difficult and its success rate is relatively low.• Length, collaterals, and attenuation-related signs can help distinguish CTO from subtotal occlusion.• The anatomical features of CTO lesions can help grade the difficulty of CTO PCI and predict procedural outcomes and long-term outcomes of CTO PCI.• The real-time fusion of CCTA with fluoroscopic angiography can be applied in highly complicated CTO lesions.• After CTO PCI, CCTA can help guide a second CTO PCI re-entry or follow up stent patency.
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Affiliation(s)
- Wei Xu
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Nanjing, China
| | - Junfeng Ma
- Emergency Medical Center, Xi'an Xianyang International Airport Co., Ltd., Xianyang, China
| | - Yiwen Chen
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Nanjing, China
| | - Fan Zhou
- Department of Radiology, Affiliated Jinling Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, China
| | - Changsheng Zhou
- Department of Radiology, Affiliated Jinling Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, 305 Zhongshan East Road, Nanjing, China.
- Department of Radiology, Affiliated Jinling Hospital of Medical School, Nanjing University, 305 Zhongshan East Road, Nanjing, China.
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15
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Wu J, Li Y, Wu D, Schoepf UJ, Zhao P, Goller M, Li J, Tian J, Shen M, Cao K, Yang L, Zhang F. The role of epicardial fat radiomic profiles for atrial fibrillation identification and recurrence risk with coronary CT angiography. Br J Radiol 2024; 97:341-352. [PMID: 38308034 DOI: 10.1093/bjr/tqad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/26/2023] [Accepted: 11/28/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES Fat radiomic profile (FRP) was a promising imaging biomarker for identifying increased cardiac risk. We hypothesize FRP can be extended to fat regions around pulmonary veins (PV), left atrium (LA), and left atrial appendage (LAA) to investigate their usefulness in identifying atrial fibrillation (AF) and the risk of AF recurrence. METHODS We analysed 300 individuals and grouped patients according to the occurrence and types of AF. We used receiver operating characteristic and survival curves analyses to evaluate the value of imaging biomarkers, including fat attenuation index (FAI) and FRP, in distinguishing AF from sinus rhythm and predicting post-ablation recurrence. RESULTS FRPs from AF-relevant fat regions showed significant performance in distinguishing AF and non-AF with higher AUC values than FAI (peri-PV: FRP = 0.961 vs FAI = 0.579, peri-LA: FRP = 0.923 vs FAI = 0.575, peri-LAA: FRP = 0.900 vs FAI = 0.665). FRPs from peri-PV, peri-LA, and peri-LAA were able to differentiate persistent and paroxysmal AF with AUC values of 0.804, 0.819, and 0.694. FRP from these regions improved AF recurrence prediction with an AUC of 0.929, 0.732, and 0.794. Patients with FRP cut-off values of ≥0.16, 0.38, and 0.26 had a 7.22-, 5.15-, and 4.25-fold higher risk of post-procedure recurrence, respectively. CONCLUSIONS FRP demonstrated potential in identifying AF, distinguishing AF types, and predicting AF recurrence risk after ablation. FRP from peri-PV fat depot exhibited a strong correlation with AF. Therefore, evaluating epicardial fat using FRP was a promising approach to enhance AF clinical management. ADVANCES IN KNOWLEDGE The role of epicardial adipose tissue (EAT) in AF had been confirmed, we focussed on the relationship between EAT around pulmonary arteries and LAA in AF which was still unknown. Meanwhile, we used the FRP to excavate more information of EAT in AF.
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Affiliation(s)
- Jingping Wu
- Department of Radiology, Hainan Hospital of PLA General Hospital, 572000 Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, 510145 Guangzhou, China
| | - Yuwei Li
- Nanzheng Intelligent Technology Corporation, 518000 Shenzhen, China
| | - Dan Wu
- Nanzheng Intelligent Technology Corporation, 518000 Shenzhen, China
| | - Uwe-Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 29425 Charleston, SC, United States
| | - Pengfei Zhao
- Shenzhen Keya Medical Technology Corporation, 518000 Shenzhen, China
| | - Markus Goller
- Department of Cardiology, Friedrich-Alexander Universität Erlangen-Nürnberg, 91056 Erlangen, Germany
| | - Junhuan Li
- Shenzhen Keya Medical Technology Corporation, 518000 Shenzhen, China
| | - Jinwen Tian
- Department of Cardiology, Hainan Hospital of PLA General Hospital, 572000 Sanya, China
| | - Mingzhi Shen
- Department of Cardiology, Hainan Hospital of PLA General Hospital, 572000 Sanya, China
| | - Kunlin Cao
- Shenzhen Keya Medical Technology Corporation, 518000 Shenzhen, China
| | - Li Yang
- Department of Radiology, The Second Medical Center of PLA General Hospital, 100089 Beijing, China
| | - Fan Zhang
- Department of Radiology, Hainan Hospital of PLA General Hospital, 572000 Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, 510145 Guangzhou, China
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16
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Safian RD. Computed Tomography-Derived Physiology Assessment: State-of-the-Art Review. Cardiol Clin 2024; 42:101-123. [PMID: 37949532 DOI: 10.1016/j.ccl.2023.07.004] [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
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization.
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Affiliation(s)
- Robert D Safian
- The Lucia Zurkowski Endowed Chair, Center for Innovation & Research in Cardiovascular Diseases (CIRC), Department of Cardiovascular Medicine, Oakland University, William Beaumont School of Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA.
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17
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Liu J, Li B, Yang Y, Huang S, Sun H, Liu J, Liu Y. A comprehensive approach to prediction of fractional flow reserve from deep-learning-augmented model. Comput Biol Med 2024; 169:107967. [PMID: 38194780 DOI: 10.1016/j.compbiomed.2024.107967] [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] [Received: 07/03/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024]
Abstract
The underuse of invasive fractional flow reserve (FFR) in clinical practice has motivated research towards non-invasive prediction of FFR. Although the non-invasive derivation of FFR (FFRCT) using computational fluid dynamics (CFD) principles has become a common practice, its clinical application has been limited due to the considerable time required for computation of resulting changes in haemodynamic conditions. An alternative to CFD technology is incorporating a neural network into the computational process to reduce the time necessary for running an effective model. In this study we propose a cascade of data-driven and physic-based neural networks (DP-NN) for predicting FFR (DL-FFRCT). The first network of cascade network DP-NN includes geometric features, and the second network includes physical features. We compare the differences between data-driven neural network (D-NN) and DP-NN for predicting FFR. The training and testing datasets were obtained by solving the three-dimensional incompressible Navier-Stokes equations. Coronary flow and geometric features were used as inputs to train D-NN. In DP-NN the training process involves first training a D-NN to output resting ΔP as one input feature to the DP-NN. Secondly, the physics-based microcirculatory resistance as another input feature to the DP-NN. Using clinically measured FFR as the "gold standard", we validated the computational accuracy of DL-FFRCT in 77 patients. Compared to D-NN, DP-NN improved the prediction of ΔP (R2 = 0.87 vs. R2 = 0.92). Statistical analysis demonstrated that the diagnostic accuracy of DL-FFRCT was not inferior to FFRCT (85.71 % vs. 88.3 %) and the computational time was reduced by a factor of approximately 3000 (4.26 s vs. 3.5 h). DP-NN represents a near real-time, interpretable, and highly accurate deep-learning network, which contributes to the development of high-performance computational methods for haemodynamics. We anticipate that DP-NN will enable near real-time prediction of DL-FFRCT in personalized narrow blood vessels and provide guidance for cardiovascular disease treatments.
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Affiliation(s)
- Jincheng Liu
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Yang Yang
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Suqin Huang
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Hao Sun
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China
| | - Jian Liu
- Cardiovascular Department, Peking University People's Hospital, Beijing, China
| | - Youjun Liu
- Department of Biomedical Engineering, College of Chemistry and Life Sciences, Beijing University of Technology, Beijing, China.
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18
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Zeng Y, Wang X, Tang Z, Li T, Jiang X, Ji F, Zhou Y, Ge J, Li Z, Zhao Y, Ma C, Mintz GS, Nie S. Diagnostic accuracy of CT-FFR with a new coarse-to-fine subpixel algorithm in detecting lesion-specific ischemia: a prospective multicenter study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:129-137. [PMID: 37453536 DOI: 10.1016/j.rec.2023.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES A new computed tomography-derived fractional flow reserve (CT-FFR) technique with a "coarse-to-fine subpixel" algorithm has been developed to generate precise lumen contours. The aim of this study was to assess the diagnostic performance of this new CT-FFR algorithm for discriminating lesion-specific ischemia using wire-based FFR ≤ 0.80 as the reference standard in patients with coronary artery disease. METHODS This prospective, multicenter study screened 330 patients undergoing coronary CT angiography (CCTA) and invasive FFR (median interval 2 days) from 6 tertiary hospitals. CT-FFR was evaluated in a blinded fashion with a "coarse-to-fine subpixel" algorithm for lumen contour. RESULTS Between March 2019 and May 2020, we included 316 patients with 324 vessels. There was a good correlation between CT-FFR and invasive FFR (r=0.76, P<.001). The diagnostic sensitivity, specificity, and accuracy on a per-vessel level were 95.3%, 89.8%, and 92.0% for CT-FFR, and 96.4%, 26.4%, and 53.1% for CCTA>50% stenosis, respectively. CT-FFR showed improved discrimination of ischemia compared with CCTA alone overall (AUC, 0.95 vs 0.74, P<.001) and in intermediate (AUC, 0.96 vs 0.62, P<.001) and "gray zone" lesions (AUC, 0.88 vs 0.61, P<.001). The diagnostic specificity, accuracy, and AUC for CT-FFR (71.9%, 82.8%, and 0.84) outperformed CCTA (9.4%, 48.3%, and 0.66) in patients or in vessels with severe calcification (all P<.05). CONCLUSIONS CT-FFR with a new "coarse-to-fine subpixel" algorithm showed high performance in identifying hemodynamically significant stenosis. The diagnostic performance of CT-FFR was superior to that of CCTA in intermediate lesions, "gray zone" lesions, and severely calcified lesions. Clinical Trial Register: NCT04731285.
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Affiliation(s)
- Yaping Zeng
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhe Tang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tianchang Li
- Department of Cardiology, Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Xuejun Jiang
- Department of Cardiology, Wuhan University Renmin Hospital, Wuhan, Hubei, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhanquan Li
- Department of Cardiology, Liaoning Provincial People's Hospital, Shenyang, China
| | - Yanyan Zhao
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changsheng Ma
- Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, United States
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
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Yin Z, Zhou C, Guo J, Wei Y, Ma Y, Zhou F, Zhu W, Zhang LJ. CT-derived fractional flow reserve in intracranial arterial stenosis: A pilot study based on computational fluid dynamics. Eur J Radiol 2024; 171:111285. [PMID: 38181628 DOI: 10.1016/j.ejrad.2024.111285] [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] [Received: 05/29/2023] [Revised: 10/14/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024]
Abstract
BACKGROUND CT-derived fractional flow reserve (CT-FFR) has been widely applied in coronary hemodynamic assessment. However, the feasieablity and standardization measurement in intracranial artery stenosis (ICAS) remains to be defined. PURPOSE To demonstrate the feasibility of CT-FFR in ICAS functional assessment and explore the optimal CT-FFR measurement position with invasive FFR as reference standard. MATERIALS AND METHODS Nineteen patients (mean age, 58.6 years ± 1.9 [SD]; 13 men) with moderate to severe (≥50 %) ICAS undergoing guidewire-based pressure measurement and preoperative head CT angiography (CTA) were retrospectively enrolled. CT-FFR was measured in the following standard measurement positions, including the end of stenosis (D0), 1 cm distal to the stenosis (D1) and 2 cm distal to the stenosis (D2). Diagnostic performance of CT-FFR was assessed by the area under the curve (AUC) of receiver operating characteristic curves by assuming invasive FFR ≤ 0.80 or 0.75 as hemodynamically significant stenosis. RESULTS Excellent intra- and inter-observer agreement (ICC range, 0.930-0.992) was observed for CT-FFR measurement in different positions. Under different FFR thresholds, the diagnostic performance of CT-FFRD1 showed perfect prediction with AUC values of 1.000 (95 % CI: 0.824, 1.000). The sensitivity, specificity and AUC of CT-FFRD1 ≤ 0.80 in detecting FFR ≤ 0.80 was 0.94 (95 % CI: 0.68, 1.00), 1.00 (95 % CI: 0.31, 1.00) and 0.969 (95 % CI: 0.772, 1.000), respectively. Similar performance of CT-FFRD1 ≤ 0.75 was obtained for identifying FFR ≤ 0.75 with the AUC of 0.964. The strongest correlation (r = 0.915, p < 0.001) and agreement (mean difference: 0.02, 95 % limits of agreement: -0.16 to 0.19) were observed between CT-FFRD1 and FFR. CONCLUSION Cerebral CT-derived fractional flow reserve (CT-FFR) measured 1 cm distal to stenosis achieved the most comparable results with invasive FFR, which indicated its potentially promising clinical application for evaluating the functional relevance of intracranial artery stenosis.
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Affiliation(s)
- Zhuhao Yin
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China
| | - Changsheng Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jian Guo
- Shanghai United Imaging Medical Technology Group Co., Ltd., Shanghai 201807, China
| | - Yuan Wei
- Shanghai United Imaging Medical Technology Group Co., Ltd., Shanghai 201807, China
| | - Yifei Ma
- Shanghai United Imaging Medical Technology Group Co., Ltd., Shanghai 201807, China
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China; Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China.
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20
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Feng Y, Fu R, Sun H, Wang X, Yang Y, Wen C, Hao Y, Sun Y, Li B, Li N, Yang H, Feng Q, Liu J, Liu Z, Zhang L, Liu Y. Non-invasive fractional flow reserve derived from reduced-order coronary model and machine learning prediction of stenosis flow resistance. Artif Intell Med 2024; 147:102744. [PMID: 38184351 DOI: 10.1016/j.artmed.2023.102744] [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] [Received: 10/05/2022] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND AND OBJECTIVE Recently, computational fluid dynamics enables the non-invasive calculation of fractional flow reserve (FFR) based on 3D coronary model, but it is time-consuming. Currently, machine learning technique has emerged as an efficient and reliable approach for prediction, which allows saving a lot of analysis time. This study aimed at developing a simplified FFR prediction model for rapid and accurate assessment of functional significance of stenosis. METHODS A reduced-order lumped parameter model (LPM) of coronary system and cardiovascular system was constructed for rapidly simulating coronary flow, in which a machine learning model was embedded for accurately predicting stenosis flow resistance at a given flow from anatomical features of stenosis. Importantly, the LPM was personalized in both structures and parameters according to coronary geometries from computed tomography angiography and physiological measurements such as blood pressure and cardiac output for personalized simulations of coronary pressure and flow. Coronary lesions with invasive FFR ≤ 0.80 were defined as hemodynamically significant. RESULTS A total of 91 patients (93 lesions) who underwent invasive FFR were involved in FFR derived from machine learning (FFRML) calculation. Of the 93 lesions, 27 lesions (29.0%) showed lesion-specific ischemia. The average time of FFRML simulation was about 10 min. On a per-vessel basis, the FFRML and FFR were significantly correlated (r = 0.86, p < 0.001). The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 91.4%, 92.6%, 90.9%, 80.6% and 96.8%, respectively. The area under the receiver-operating characteristic curve of FFRML was 0.984. CONCLUSION In this selected cohort of patients, the FFRML improves the computational efficiency and ensures the accuracy. The favorable performance of FFRML approach greatly facilitates its potential application in detecting hemodynamically significant coronary stenosis in future routine clinical practice.
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Affiliation(s)
- Yili Feng
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Ruisen Fu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Hao Sun
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Xue Wang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; Department of Equipment and Materials, Tianjin First Central Hospital, Tianjin, China
| | - Yang Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Chuanqi Wen
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yaodong Hao
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Yutong Sun
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Na Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China; School of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong 271016, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China
| | - Quansheng Feng
- Department of Cardiology, The First People's Hospital of Guangshui, Hubei 432700, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Zhuo Liu
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
| | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing 100124, China.
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Gohmann RF, Schug A, Pawelka K, Seitz P, Majunke N, El Hadi H, Heiser L, Renatus K, Desch S, Leontyev S, Noack T, Kiefer P, Krieghoff C, Lücke C, Ebel S, Borger MA, Thiele H, Panknin C, Abdel-Wahab M, Horn M, Gutberlet M. Interrater variability of ML-based CT-FFR during TAVR-planning: influence of image quality and coronary artery calcifications. Front Cardiovasc Med 2023; 10:1301619. [PMID: 38188259 PMCID: PMC10768187 DOI: 10.3389/fcvm.2023.1301619] [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: 09/25/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To compare machine learning (ML)-based CT-derived fractional flow reserve (CT-FFR) in patients before transcatheter aortic valve replacement (TAVR) by observers with differing training and to assess influencing factors. Background Coronary computed tomography angiography (cCTA) can effectively exclude CAD, e.g. prior to TAVR, but remains limited by its specificity. CT-FFR may mitigate this limitation also in patients prior to TAVR. While a high reliability of CT-FFR is presumed, little is known about the reproducibility of ML-based CT-FFR. Methods Consecutive patients with obstructive CAD on cCTA were evaluated with ML-based CT-FFR by two observers. Categorization into hemodynamically significant CAD was compared against invasive coronary angiography. The influence of image quality and coronary artery calcium score (CAC) was examined. Results CT-FFR was successfully performed on 214/272 examinations by both observers. The median difference of CT-FFR between both observers was -0.05(-0.12-0.02) (p < 0.001). Differences showed an inverse correlation to the absolute CT-FFR values. Categorization into CAD was different in 37/214 examinations, resulting in net recategorization of Δ13 (13/214) examinations and a difference in accuracy of Δ6.1%. On patient level, correlation of absolute and categorized values was substantial (0.567 and 0.570, p < 0.001). Categorization into CAD showed no correlation to image quality or CAC (p > 0.13). Conclusion Differences between CT-FFR values increased in values below the cut-off, having little clinical impact. Categorization into CAD differed in several patients, but ultimately only had a moderate influence on diagnostic accuracy. This was independent of image quality or CAC.
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Affiliation(s)
- Robin F. Gohmann
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Adrian Schug
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Konrad Pawelka
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Patrick Seitz
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Nicolas Majunke
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Hamza El Hadi
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Linda Heiser
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
| | - Katharina Renatus
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Philipp Kiefer
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | | | | | - Sebastian Ebel
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Michael A. Borger
- Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Helios Health Institute, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
- Helios Health Institute, Leipzig, Germany
| | | | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Matthias Horn
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Heart Center Leipzig, Leipzig, Germany
- Medical Faculty, University of Leipzig, Leipzig, Germany
- Helios Health Institute, Leipzig, Germany
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22
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Aromiwura AA, Settle T, Umer M, Joshi J, Shotwell M, Mattumpuram J, Vorla M, Sztukowska M, Contractor S, Amini A, Kalra DK. Artificial intelligence in cardiac computed tomography. Prog Cardiovasc Dis 2023; 81:54-77. [PMID: 37689230 DOI: 10.1016/j.pcad.2023.09.001] [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: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/11/2023]
Abstract
Artificial Intelligence (AI) is a broad discipline of computer science and engineering. Modern application of AI encompasses intelligent models and algorithms for automated data analysis and processing, data generation, and prediction with applications in visual perception, speech understanding, and language translation. AI in healthcare uses machine learning (ML) and other predictive analytical techniques to help sort through vast amounts of data and generate outputs that aid in diagnosis, clinical decision support, workflow automation, and prognostication. Coronary computed tomography angiography (CCTA) is an ideal union for these applications due to vast amounts of data generation and analysis during cardiac segmentation, coronary calcium scoring, plaque quantification, adipose tissue quantification, peri-operative planning, fractional flow reserve quantification, and cardiac event prediction. In the past 5 years, there has been an exponential increase in the number of studies exploring the use of AI for cardiac computed tomography (CT) image acquisition, de-noising, analysis, and prognosis. Beyond image processing, AI has also been applied to improve the imaging workflow in areas such as patient scheduling, urgent result notification, report generation, and report communication. In this review, we discuss algorithms applicable to AI and radiomic analysis; we then present a summary of current and emerging clinical applications of AI in cardiac CT. We conclude with AI's advantages and limitations in this new field.
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Affiliation(s)
| | - Tyler Settle
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA
| | - Muhammad Umer
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Jonathan Joshi
- Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Matthew Shotwell
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Jishanth Mattumpuram
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Mounica Vorla
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Maryta Sztukowska
- Clinical Trials Unit, University of Louisville, Louisville, KY, USA; University of Information Technology and Management, Rzeszow, Poland
| | - Sohail Contractor
- Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Amir Amini
- Medical Imaging Laboratory, Department of Electrical and Computer Engineering, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA
| | - Dinesh K Kalra
- Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA; Center for Artificial Intelligence in Radiological Sciences (CAIRS), Department of Radiology, University of Louisville, Louisville, KY, USA.
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Zhang XL, Zhang B, Tang CX, Wang YN, Zhang JY, Yu MM, Hou Y, Zheng MW, Zhang DM, Hu XH, Xu L, Liu H, Sun ZY, Zhang LJ. Machine learning based ischemia-specific stenosis prediction: A Chinese multicenter coronary CT angiography study. Eur J Radiol 2023; 168:111133. [PMID: 37827088 DOI: 10.1016/j.ejrad.2023.111133] [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] [Received: 07/23/2023] [Revised: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To evaluate the performance of coronary computed tomography angiography (CCTA) derived characteristics including CT derived fractional flow reserve (CT-FFR) with FFR as a reference standard in identifying the lesion-specific ischemia by machine learning (ML) algorithms. METHODS The retrospective analysis enrolled 596 vessels in 462 patients (mean age, 61 years ± 11 [SD]; 71.4 % men) with suspected coronary artery disease who underwent CCTA and invasive FFR. The data were divided into training cohort, internal validation cohort, external validation cohorts 1 and 2 according to participating centers. All CCTA-derived parameters, which contained 10 qualitative and 33 quantitative plaque parameters, were collected to establish ML model. The Boruta and unsupervised clustering algorithm were implemented to select important and non-redundant parameters. Finally, the eight features with the highest mean importance were included for further ML model establishment and decision tree building. Five models were built to predict lesion-specific ischemia: stenosis degree from CCTA, CT-FFR, ΔCT-FFR, ML model and nested model. RESULTS Low-attenuation plaque, bend and lesion length were the main predictors of ischemia-specific lesions. Of 5 models, the ML model showed favorable discrimination for ischemia-specific lesions in the training and three validation sets (area under the curve [95 % confidence interval], 0.93 [0.90-0.96], 0.86 [0.79-0.94], 0.88 [0.83-0.94], and 0.90 [0.84-0.96], respectively). The nested model which combined the ML model and CT-FFR showed better diagnostic efficacy (AUC [95 %CI], 0.96 [0.94-0.99], 0.92 [0.86-0.99], 0.92 [0.86-0.99] and 0.94 [0.91-0.98], respectively; all P < 0.05), and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were significantly higher than CT-FFR alone. CONCLUSIONS Comprehensive CCTA-derived multiparameter model could better predict the ischemia-specific lesions by ML algorithms compared to stenosis degree from CTA, CT-FFR and ΔCT-FFR. Decision tree can be used to predict myocardial ischemia effectively.
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Affiliation(s)
- Xiao Lei Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Bo Zhang
- Department of Radiology, Jiangsu Taizhou People's Hospital, Taizhou, Jiangsu 225300, PR China
| | - Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, PR China
| | - Jia Yin Zhang
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Meng Meng Yu
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao tong University Affiliated Sixth People's Hospital, Shanghai 200233, PR China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning 110001, PR China
| | - Min Wen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi 710032, PR China
| | - Dai Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, PR China
| | - Xiu Hua Hu
- Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang 310006, PR China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 10029, PR China
| | - Hui Liu
- Department of Radiology, Guangdong Province People's Hospital, Guangzhou, Guangdong 510000, PR China
| | - Zhi Yuan Sun
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, PR China.
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Ding Y, Li Q, Chen Q, Tang Y, Zhang H, He Y, Fu G, Yang Q, Shou X, Ye Y, Zhao X, Zhang Y, Li Y, Zhang X, Wu C, Wang R, Xu L, Zhang R, Yeung A, Zeng Y, Qian X. Diagnostic performance of a novel automated CT-derived FFR technology in detecting hemodynamically significant coronary artery stenoses: A multicenter trial in China. Am Heart J 2023; 265:180-190. [PMID: 37611856 DOI: 10.1016/j.ahj.2023.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/17/2023] [Accepted: 08/12/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND AND AIMS Computed tomography-derived fractional flow reserve (CT-derived FFR) algorithms have emerged as promising noninvasive methods for identifying hemodynamically significant coronary artery disease (CAD). However, its broad adaption is limited by the complex workflow, slow processing, and supercomputer requirement. Therefore, CT-derived FFR solutions capable of producing fast and accurate results could help deliver time-sensitive results rapidly and potentially alter patient management. The current study aimed to determine the diagnostic performance of a novel CT-derived FFR algorithm, esFFR, on patients with CAD was evaluated. METHODS 329 patients from 6 medical centers in China were included in this prospective study. CT-derived FFR calculations were performed on 350 vessels using the esFFR algorithm using patients' presenting coronary computed tomography angiography (CCTA) images, and results and processing speed were recorded. Using invasive FFR measurements from direct coronary angiography as the reference standard, the diagnostic performance of esFFR and CCTA in detecting hemodynamically significant lesions were compared. Post-hoc analyses were performed for patients with calcified lesions or stenoses within the CT-derived FFR diagnostic "gray zone." RESULTS The esFFR values correlated well with invasive FFR. The sensitivity, specificity, accuracy, positive and negative predictive value for esFFR were all above 90%. The overall performance of esFFR was superior to CCTA. Coronary calcification had minimal effects on esFFR's diagnostic performance. It also maintained 85% of diagnostic accuracy for "gray zone" lesions, which historically was <50%. The average esFFR processing speed was 4.6 ± 1.3 minutes. CONCLUSIONS The current study demonstrated esFFR had high diagnostic efficacy and fast processing speed in identifying hemodynamically significant CAD.
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Affiliation(s)
- Yaodong Ding
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Quan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - QiLiang Chen
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA
| | - Yida Tang
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Haitao Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan, China
| | - Guosheng Fu
- Department of Cardiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Qing Yang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiling Shou
- Department of Cardiology, Shanxi Provincial People's Hospital, Shanxi, China
| | - Yicong Ye
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiliang Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoling Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changyan Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ren Zhang
- Department of Cardiology, Hendrick Medical Center, Abilene, TX
| | - Alan Yeung
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA
| | - Yong Zeng
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
| | - Xiang Qian
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA.
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25
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Zhang H, Wu R, Yang N, Xie J, Hou Y. Research on individualized distribution approach of coronary resting blood flow for noninvasive calculation of fractional flow reserve. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 240:107704. [PMID: 37429248 DOI: 10.1016/j.cmpb.2023.107704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 06/15/2023] [Accepted: 06/30/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND OBJECTIVES The distribution of coronary resting blood flow is critical for accurately calculating the computed tomography (CT) angiography-derived fractional flow reserve (FFRCT). However, the diagnostic accuracy of FFRCT calculated by the fixed exponents between two risk factors and coronary resting blood flow, including myocardial mass and diameter of the coronary artery branch, was insufficient compared with invasive fractional flow reserve (FFR). In this study, we proposed the individualized distribution of coronary resting blood flow based on coronary ultrasound blood flow measurement, to improve the diagnostic accuracy of FFRCT calculation. METHODS Five risk factors and an unknown coefficient K were integrated to calculate the individualized distribution of coronary resting blood flow. The K value was fit using the least square method based on coronary ultrasound blood flow measurement results of 30 volunteers. We developed a novel approach for calculating the individualized distribution of coronary resting blood flow and applied it to calculate FFRCT (FFRCTI). Then, we tested the performance of the individualized distribution approach by comparing it with the approach proposed by Taylor based on coronary ultrasound blood flow measurement results of 13 volunteers. Finally, we tested the diagnostic accuracy of FFRCT calculated by two approaches in invasive FFR of 121 vessels with coronary stenosis. RESULTS We identified five risk factors and 6.83×10-5 for K value, including cardiac output, mean arterial pressure, myocardial mass, coronary artery volume, and diameter of the coronary artery branch, to calculate the individualized distribution of coronary resting blood flow. The mean square error of the individualized distribution approach (0.0088) was significantly less than that of the approach proposed by Taylor (0.0799). The diagnostic accuracy of FFRCTI calculated by the individualized distribution approach (91.74%) was higher than that of the approach proposed by Taylor (FFRCTT) (82.64%). CONCLUSIONS The individualized distribution approach of coronary resting blood flow can significantly improve the diagnostic accuracy of FFRCT calculation compared with invasive FFR, and support its wide clinical application for diagnosing myocardial ischemia caused by coronary stenosis.
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Affiliation(s)
- Honghui Zhang
- College of Engineering, Inner Mongolia Minzu University, Tongliao 028000, China
| | - Rile Wu
- Department of Neurology, Tong Liao City Hospital, Tongliao 028007, China
| | - Ning Yang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, China.
| | - Jinjie Xie
- Department of Echocardiography, Jiahui International Hospital, Shanghai 200233, China
| | - Yang Hou
- Shengjing Hospital, China Medical University, Shenyang 110001, China
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Hou J, Zheng G, Han L, Shu Z, Wang H, Yuan Z, Peng J, Gong X. Coronary computed tomography angiography imaging features combined with computed tomography-fractional flow reserve, pericoronary fat attenuation index, and radiomics for the prediction of myocardial ischemia. J Nucl Cardiol 2023; 30:1838-1850. [PMID: 36859595 DOI: 10.1007/s12350-023-03221-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/19/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND This study aimed to predict myocardial ischemia (MIS) by constructing models with imaging features, CT-fractional flow reserve (CT-FFR), pericoronary fat attenuation index (pFAI), and radiomics based on coronary computed tomography angiography (CCTA). METHODS AND RESULTS This study included 96 patients who underwent CCTA and single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI). According to SPECT-MPI results, there were 72 vessels with MIS in corresponding supply area and 105 vessels with no-MIS. The conventional model [lesion length (LL), MDS (maximum stenosis diameter × 100% / reference vessel diameter), MAS (maximum stenosis area × 100% / reference vessel area) and CT value], radiomics model (radiomics features), and multi-faceted model (all features) were constructed using support vector machine. Conventional and radiomics models showed similar predictive efficacy [AUC: 0.76, CI 0.62-0.90 vs. 0.74, CI 0.61-0.88; p > 0.05]. Adding pFAI to the conventional model showed better predictive efficacy than adding CT-FFR (AUC: 0.88, CI 0.79-0.97 vs. 0.80, CI 0.68-0.92; p < 0.05). Compared with conventional and radiomics model, the multi-faceted model showed the highest predictive efficacy (AUC: 0.92, CI 0.82-0.98, p < 0.05). CONCLUSION pFAI is more effective for predicting MIS than CT-FFR. A multi-faceted model combining imaging features, CT-FFR, pFAI, and radiomics is a potential diagnostic tool for MIS.
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Affiliation(s)
- Jie Hou
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Address: No. 158 Shangtang Road, Hanghzou City, 310014, Zhejiang Province, China
| | - Guangying Zheng
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Lu Han
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Zhenyu Shu
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Address: No. 158 Shangtang Road, Hanghzou City, 310014, Zhejiang Province, China
| | - Haochu Wang
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Address: No. 158 Shangtang Road, Hanghzou City, 310014, Zhejiang Province, China
| | - Zhongyu Yuan
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Jiaxuan Peng
- Jinzhou Medical University, Jinzhou, Liaoning Province, China
| | - Xiangyang Gong
- Heart Center, Department of Radiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Address: No. 158 Shangtang Road, Hanghzou City, 310014, Zhejiang Province, China.
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Yao X, Zhong S, Xu M, Zhang G, Yuan Y, Shuai T, Li Z. Deep learning-based motion correction algorithm for coronary CT angiography: Lowering the phase requirement for morphological and functional evaluation. J Appl Clin Med Phys 2023; 24:e14104. [PMID: 37485892 PMCID: PMC10476979 DOI: 10.1002/acm2.14104] [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] [Received: 03/13/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
PURPOSE To investigate the performance of a deep learning-based motion correction algorithm (MCA) at various cardiac phases of coronary computed tomography angiography (CCTA), and determine the extent to which it may allow for reliable morphological and functional evaluation. MATERIALS AND METHODS The acquired image data of 53 CCTA cases, where the patient heart rate (HR) was ≥75 bpm, were reconstructed at 0, ±2, ±4, ±6, and ±8% deviations from each optimal systolic phase, with and without the MCA, yielding a total of 954 images (53 cases × 9 phases × 2 reconstructions). The overall image quality and diagnostic confidence were graded by two radiologists using a 5-point scale, with scores ≥3 being deemed clinically interpretable. Signal-to-noise ratio, contrast-to-noise ratio, vessel sharpness, and circularity were measured. The CCTA-derived fractional flow reserve (CT-FFR) was calculated in 38 vessels on 24 patients to identify functionally significant stenosis, using the invasive fractional flow reserve (FFR) as reference. All metrics were compared between two reconstructions at various phases. RESULTS Inferior image quality was observed as the phase deviation was enlarged. However, MCA significantly improved the image quality at nonoptimal phases and the optimal phase. Coronary artery evaluation was feasible within 4% phase deviation using MCA, with interpretable overall image quality and high diagnostic confidence. With MCA, the performance of identifying functionally significant stenosis via CT-FFR was increased for images at various phase deviations. However, obvious decrease in accuracy, as compared to the image at the optimal phase, was found on those with deviations >4%. CONCLUSION The deep learning-based MCA allows up to 4% phase deviation in acquiring CCTA for reliable morphological and functional evaluation on patients with high HRs.
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Affiliation(s)
- Xiaoling Yao
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | | | - Maolan Xu
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | | | - Yuan Yuan
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Tao Shuai
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
| | - Zhenlin Li
- Department of RadiologyWest China Hospital of Sichuan UniversityChengduChina
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28
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Zhang H, Song X, Wu R, Li N, Hou Q, Xie J, Hou Y, Qiao A. A novel method for noninvasive quantification of fractional flow reserve based on the custom function. Front Bioeng Biotechnol 2023; 11:1207300. [PMID: 37711442 PMCID: PMC10498765 DOI: 10.3389/fbioe.2023.1207300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/21/2023] [Indexed: 09/16/2023] Open
Abstract
Boundary condition settings are key risk factors for the accuracy of noninvasive quantification of fractional flow reserve (FFR) based on computed tomography angiography (i.e., FFRCT). However, transient numerical simulation-based FFRCT often ignores the three-dimensional (3D) model of coronary artery and clinical statistics of hyperemia state set by boundary conditions, resulting in insufficient computational accuracy and high computational cost. Therefore, it is necessary to develop the custom function that combines the 3D model of the coronary artery and clinical statistics of hyperemia state for boundary condition setting, to accurately and quickly quantify FFRCT under steady-state numerical simulations. The 3D model of the coronary artery was reconstructed by patient computed tomography angiography (CTA), and coronary resting flow was determined from the volume and diameter of the 3D model. Then, we developed the custom function that took into account the interaction of stenotic resistance, microcirculation resistance, inlet aortic pressure, and clinical statistics of resting to hyperemia state due to the effect of adenosine on boundary condition settings, to accurately and rapidly identify coronary blood flow for quantification of FFRCT calculation (FFRU). We tested the diagnostic accuracy of FFRU calculation by comparing it with the existing methods (CTA, coronary angiography (QCA), and diameter-flow method for calculating FFR (FFRD)) based on invasive FFR of 86 vessels in 73 patients. The average computational time for FFRU calculation was greatly reduced from 1-4 h for transient numerical simulations to 5 min per simulation, which was 2-fold less than the FFRD method. According to the results of the Bland-Altman analysis, the consistency between FFRU and invasive FFR of 86 vessels was better than that of FFRD. The area under the receiver operating characteristic curve (AUC) for CTA, QCA, FFRD and FFRU at the lesion level were 0.62 (95% CI: 0.51-0.74), 0.67 (95% CI: 0.56-0.79), 0.85 (95% CI: 0.76-0.94), and 0.93 (95% CI: 0.87-0.98), respectively. At the patient level, the AUC was 0.61 (95% CI: 0.48-0.74) for CTA, 0.65 (95% CI: 0.53-0.77) for QCA, 0.83 (95% CI: 0.74-0.92) for FFRD, and 0.92 (95% CI: 0.89-0.96) for FFRU. The proposed novel method might accurately and rapidly identify coronary blood flow, significantly improve the accuracy of FFRCT calculation, and support its wide application as a diagnostic indicator in clinical practice.
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Affiliation(s)
- Honghui Zhang
- Key Laboratory of Intelligent Manufacturing Technology, College of Engineering, Inner Mongolia Minzu University, Tongliao, China
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Xiaorui Song
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
| | - Rile Wu
- Department of Neurology, Tong Liao City Hospital, Tongliao, China
| | - Na Li
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, Tai’an, China
| | - Qianwen Hou
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Jinjie Xie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Echocardiography, Jiahui International Hospital, Shanghai, China
| | - Yang Hou
- Shengjing Hospital, China Medical University, Shenyang, China
| | - Aike Qiao
- Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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Liu Z, Ding Y, Dou G, Wang X, Shan D, He B, Jing J, Li T, Chen Y, Yang J. Global trans-lesional computed tomography-derived fractional flow reserve gradient is associated with clinical outcomes in diabetic patients with non-obstructive coronary artery disease. Cardiovasc Diabetol 2023; 22:186. [PMID: 37496009 PMCID: PMC10373274 DOI: 10.1186/s12933-023-01901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) enables physiological assessment and risk stratification, which is of significance in diabetic patients with nonobstructive coronary artery disease (CAD). We aim to evaluate prognostic value of the global trans-lesional CT-FFR gradient (GΔCT-FFR), a novel metric, in patients with diabetes without flow-limiting stenosis. METHODS Patients with diabetes suspected of having CAD were prospectively enrolled. GΔCT-FFR was calculated as the sum of trans-lesional CT-FFR gradient in all epicardial vessels greater than 2 mm. Patients were stratified into low-gradient without flow-limiting group (CT-FFR > 0.75 and GΔCT-FFR < 0.20), high-gradient without flow-limiting group (CT-FFR > 0.75 and GΔCT-FFR ≥ 0.20), and flow-limiting group (CT-FFR ≤ 0.75). Discriminant ability for major adverse cardiovascular events (MACE) prediction was compared among 4 models [model 1: Framingham risk score; model 2: model 1 + Leiden score; model 3: model 2 + high-risk plaques (HRP); model 4: model 3 + GΔCT-FFR] to determine incremental prognostic value of GΔCT-FFR. RESULTS Of 1215 patients (60.1 ± 10.3 years, 53.7% male), 11.3% suffered from MACE after a median follow-up of 57.3 months. GΔCT-FFR (HR: 2.88, 95% CI 1.76-4.70, P < 0.001) remained independent risk factors of MACE in multivariable analysis. Compared with the low-gradient without flow-limiting group, the high-gradient without flow-limiting group (HR: 2.86, 95% CI 1.75-4.68, P < 0.001) was associated with higher risk of MACE. Among the 4 risk models, model 4, which included GΔCT-FFR, showed the highest C-statistics (C-statistics: 0.75, P = 0.002) as well as a significant net reclassification improvement (NRI) beyond model 3 (NRI: 0.605, P < 0.001). CONCLUSIONS In diabetic patients with non-obstructive CAD, GΔCT-FFR was associated with clinical outcomes at 5 year follow-up, which illuminates a novel and feasible approach to improved risk stratification for a global hemodynamic assessment of coronary artery in diabetic patients.
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Affiliation(s)
- Zinuan Liu
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Yipu Ding
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Guanhua Dou
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xi Wang
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Dongkai Shan
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Bai He
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Jing Jing
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Tao Li
- Department of Radiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China.
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China.
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Huang W, Zhang J, Yang L, Hu Y, Leng X, Liu Y, Jin H, Tang Y, Wang J, Liu X, Guo Y, Ye C, Feng Y, Xiang J, Tang L, Du C. Accuracy of intravascular ultrasound-derived virtual fractional flow reserve (FFR) and FFR derived from computed tomography for functional assessment of coronary artery disease. Biomed Eng Online 2023; 22:64. [PMID: 37370077 DOI: 10.1186/s12938-023-01122-x] [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: 03/05/2023] [Accepted: 05/28/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Coronary computed tomography-derived fractional flow reserve (CT-FFR) and intravascular ultrasound-derived fractional flow reserve (IVUS-FFR) are two functional assessment methods for coronary stenoses. However, the calculation algorithms for these methods differ significantly. This study aimed to compare the diagnostic performance of CT-FFR and IVUS-FFR using invasive fractional flow reserve (FFR) as the reference standard. METHODS Six hundred and seventy patients (698 lesions) with known or suspected coronary artery disease were screened for this retrospective analysis between January 2020 and July 2021. A total of 40 patients (41 lesions) underwent intravascular ultrasound (IVUS) and FFR evaluations within six months after completing coronary CT angiography were included. Two novel CFD-based models (AccuFFRct and AccuFFRivus) were used to compute the CT-FFR and IVUS-FFR values, respectively. The invasive FFR ≤ 0.80 was used as the reference standard for evaluating the diagnostic performance of CT-FFR and IVUS-FFR. RESULTS Both AccuFFRivus and AccuFFRct demonstrated a strong correlation with invasive FFR (R = 0.7913, P < 0.0001; and R = 0.6296, P < 0.0001), and both methods showed good agreement with FFR. The area under the receiver operating characteristic curve was 0.960 (P < 0.001) for AccuFFRivus and 0.897 (P < 0.001) for AccuFFRct in predicting FFR ≤ 0.80. FFR ≤ 0.80 were predicted with high sensitivity (96.6%), specificity (85.7%), and the Youden index (0.823) using the same cutoff value of 0.80 for AccuFFRivus. A good diagnostic performance (sensitivity 89.7%, specificity 85.7%, and Youden index 0.754) was also demonstrated by AccuFFRct. CONCLUSIONS AccuFFRivus, computed from IVUS images, exhibited a high diagnostic performance for detecting myocardial ischemia. It demonstrated better diagnostic power than AccuFFRct, and could serve as an accurate computational tool for ischemia diagnosis and assist in clinical decision-making.
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Affiliation(s)
- Wenhao Huang
- Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jingyuan Zhang
- Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lin Yang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yumeng Hu
- ArteryFlow Technology Co., Ltd., Hangzhou, China
| | | | - Yajun Liu
- Department of Medicine, The Second College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hongfeng Jin
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Yiming Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Jiangting Wang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Xiaowei Liu
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Yitao Guo
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Chen Ye
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Yue Feng
- Department of Radiology, Zhejiang Hospital, Hangzhou, China
| | | | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
| | - Changqing Du
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China.
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Hu X, Liu X, Wang H, Xu L, Wu P, Zhang W, Niu Z, Zhang L, Gao Q. A novel physics-based model for fast computation of blood flow in coronary arteries. Biomed Eng Online 2023; 22:56. [PMID: 37303051 DOI: 10.1186/s12938-023-01121-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 05/28/2023] [Indexed: 06/13/2023] Open
Abstract
Blood flow and pressure calculated using the currently available methods have shown the potential to predict the progression of pathology, guide treatment strategies and help with postoperative recovery. However, the conspicuous disadvantage of these methods might be the time-consuming nature due to the simulation of virtual interventional treatment. The purpose of this study is to propose a fast novel physics-based model, called FAST, for the prediction of blood flow and pressure. More specifically, blood flow in a vessel is discretized into a number of micro-flow elements along the centerline of the artery, so that when using the equation of viscous fluid motion, the complex blood flow in the artery is simplified into a one-dimensional (1D) steady-state flow. We demonstrate that this method can compute the fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA). 345 patients with 402 lesions are used to evaluate the feasibility of the FAST simulation through a comparison with three-dimensional (3D) computational fluid dynamics (CFD) simulation. Invasive FFR is also introduced to validate the diagnostic performance of the FAST method as a reference standard. The performance of the FAST method is comparable with the 3D CFD method. Compared with invasive FFR, the accuracy, sensitivity and specificity of FAST is 88.6%, 83.2% and 91.3%, respectively. The AUC of FFRFAST is 0.906. This demonstrates that the FAST algorithm and 3D CFD method show high consistency in predicting steady-state blood flow and pressure. Meanwhile, the FAST method also shows the potential in detecting lesion-specific ischemia.
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Affiliation(s)
- Xiuhua Hu
- Department of Radiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingli Liu
- Hangzhou Shengshi Science and Technology Co., Ltd., Hangzhou, China
| | - Hongping Wang
- The State Key Laboratory of Nonlinear Mechanics, Institute of Mechanics, Chinese Academy of Sciences, Beijing, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Peng Wu
- Biomanufacturing Research Centre, School of Mechanical and Electric Engineering, Soochow University, Suzhou, Jiangsu, China
| | - Wenbing Zhang
- Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhaozhuo Niu
- Department of Cardiac Surgery, Qingdao Municipal Hospital, Qingdao, China
| | - Longjiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China.
| | - Qi Gao
- Institute of Fluid Engineering, School of Aeronautics and Astronautics, Zhejiang University, Hangzhou, China.
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Chen YC, Zhou F, Wang YN, Zhang JY, Yu MM, Hou Y, Xu PP, Zhang XL, Xue Y, Zheng MW, Zhang B, Zhang DM, Hu XH, Xu L, Liu H, Lu GM, Tang CX, Zhang LJ. Optimal Measurement Sites of Coronary-Computed Tomography Angiography-derived Fractional Flow Reserve: The Insight From China CT-FFR Study. J Thorac Imaging 2023; 38:194-202. [PMID: 36469852 DOI: 10.1097/rti.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To investigate the optimal measurement site of coronary-computed tomography angiography-derived fractional flow reserve (FFR CT ) for the assessment of coronary artery disease (CAD) in the whole clinical routine practice. MATERIALS AND METHODS This retrospective multicenter study included 396 CAD patients who underwent coronary-computed tomography angiography, FFR CT , and invasive FFR. FFR CT was measured at 1 cm (FFR CT -1 cm), 2 cm (FFR CT -2 cm), 3 cm (FFR CT -3 cm), and 4 cm (FFR CT -4 cm) distal to coronary stenosis, respectively. FFR CT and invasive FFR ≤0.80 were defined as lesion-specific ischemia. The diagnostic performance of FFR CT to detect ischemia was obtained using invasive FFR as the reference standard. Reduced invasive coronary angiography rate and revascularization efficiency were calculated. After a median follow-up of 35 months in 267 patients for major adverse cardiovascular events (MACE), Cox hazard proportional models were performed with FFR CT values at each measurement site. RESULTS For discriminating lesion-specific ischemia, the areas under the curve of FFR CT -1 cm (0.91) as well as FFR CT -2 cm (0.91) were higher than those of FFR CT -3 cm (0.89) and FFR CT -4 cm (0.88), respectively (all P <0.05). The higher reduced invasive coronary angiography rate (81.6%) was found at FFR CT -1 cm than FFR CT -2 cm (81.6% vs. 62.6%, P <0.05). Revascularization efficiency did not differ between FFR CT -1 cm and FFR CT -2 cm (80.8% vs. 65.5%, P =0.019). In 12.4% (33/267) MACE occurred and only values of FFR CT -2 cm were independently predictive of MACE (hazard ratio: 0.957 [95% CI: 0.925-0.989]; P =0.010). CONCLUSIONS This study indicates FFR CT -2 cm is the optimal measurement site with superior diagnostic performance and independent prognostic role.
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Affiliation(s)
- Yan Chun Chen
- Department of Diagnostic Radiology, Jinling Hospital
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Yi Ning Wang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jia Yin Zhang
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Institute of Diagnostic and Interventional Radiology, Shanghai
| | - Meng Meng Yu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Institute of Diagnostic and Interventional Radiology, Shanghai
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang
| | - Peng Peng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Xiao Lei Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, the First School of Clinical Medicine, Southern Medical University, Nanjing
| | - Min Wen Zheng
- Department of Radiology, Xijing Hospital, Air Force Military Medical University, Xi'an
| | - Bo Zhang
- Department of Radiology, Taizhou People's Hospital, Taizhou, Jiangsu
| | - Dai Min Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University
| | - Xiu Hua Hu
- Zhejiang University School of Medicine, Sir Run Run Shaw Hospital, Hangzhou, Zhejiang
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing
| | - Hui Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Guang Ming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Chun Xiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
| | - Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University
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Liu J, Li B, Zhang Y, Zhang L, Huang S, Sun H, Liu J, Zhao X, Zhang M, Wang W, Liu Y. A high-fidelity geometric multiscale hemodynamic model for predicting myocardial ischemia. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 233:107476. [PMID: 36933317 DOI: 10.1016/j.cmpb.2023.107476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) requires a maximal hyperemic state to be modeled by assuming the total coronary resistance decreased to a constant 0.24 of that under the resting state. However, this assumption neglects the vasodilator capacity of individual patients. Herein, we proposed a high-fidelity geometric multiscale model (HFMM) to characterize coronary pressure and flow under the resting state, seeking to better predict myocardial ischemia by using CCTA-derived instantaneous wave-free ratio (CT-iFR). METHODS Fifty-seven patients (62 lesions) who had undergone CCTA and were then referred to invasive FFR were prospectively enrolled. The coronary microcirculation resistance hemodynamic model (RHM) under the resting condition was established on a patient-specific basis. Coupled with a closed-loop geometric multiscale model (CGM) of their individual coronary circulations, the HFMM model was established to non-invasively derive the CT-iFR from CCTA images. RESULTS With the invasive FFR being the reference standard, accuracy of the obtained CT-iFR in identifying myocardial ischemia was greater than those of the CCTA and non-invasively derived CT-FFR (90.32% vs. 79.03% vs. 84.3%). The overall computational time of CT-iFR was 61 ± 6 min, faster than that of the CT-FFR (8 h). The sensitivity, specificity, positive predictive value, and negative predictive value of the CT-iFR in discriminating an invasive FFR > 0.8 were 78% (95% CI: 40-97%), 92% (95% CI: 82-98%), 64% (95% CI: 39-83%), and 96% (95% CI:88-99%), respectively. CONCLUSIONS A high-fidelity geometric multiscale hemodynamic model was developed for rapid and accurate estimation of CT-iFR. Compared with CT-FFR, CT-iFR is of less computational cost and enables assessment of tandem lesions.
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Affiliation(s)
- Jincheng Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Bao Li
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Yanping Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Liyuan Zhang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Suqin Huang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Hao Sun
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Jian Liu
- Department of Cardiology, Peking University People's Hospital, Beijing, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Mingzi Zhang
- Macquarie Medical School, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney, Australia
| | | | - Youjun Liu
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China.
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Gao X, Wang R, Sun Z, Zhang H, Bo K, Xue X, Yang J, Xu L. A Novel CT Perfusion-Based Fractional Flow Reserve Algorithm for Detecting Coronary Artery Disease. J Clin Med 2023; 12:jcm12062154. [PMID: 36983156 PMCID: PMC10058085 DOI: 10.3390/jcm12062154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/12/2023] Open
Abstract
Background: The diagnostic accuracy of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA) (FFR-CT) needs to be further improved despite promising results available in the literature. While an innovative myocardial computed tomographic perfusion (CTP)-derived fractional flow reserve (CTP-FFR) model has been initially established, the feasibility of CTP-FFR to detect coronary artery ischemia in patients with suspected coronary artery disease (CAD) has not been proven. Methods: This retrospective study included 93 patients (a total of 103 vessels) who received CCTA and CTP for suspected CAD. Invasive coronary angiography (ICA) was performed within 2 weeks after CCTA and CTP. CTP-FFR, CCTA (stenosis ≥ 50% and ≥70%), ICA, FFR-CT and CTP were assessed by independent laboratory experts. The diagnostic ability of the CTP-FFR grouped by quantitative coronary angiography (QCA) in mild (30–49%), moderate (50–69%) and severe stenosis (≥70%) was calculated. The effect of calcification of lesions, grouped by FFR on CTP-FFR measurements, was also assessed. Results: On the basis of per-vessel level, the AUCs for CTP-FFR, CTP, FFR-CT and CCTA were 0.953, 0.876, 0.873 and 0.830, respectively (all p < 0.001). The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of CTP-FFR for per-vessel level were 0.87, 0.88, 0.87, 0.85 and 0.89 respectively, compared with 0.87, 0.54, 0.69, 0.61, 0.83 and 0.75, 0.73, 0.74, 0.70, 0.77 for CCTA ≥ 50% and ≥70% stenosis, respectively. On the basis of per-vessel analysis, CTP-FFR had higher specificity, accuracy and AUC compared with CCTA and also higher AUC compared with FFR-CT or CTP (all p < 0.05). The sensitivity and accuracy of CTP-FFR + CTP + FFR-CT were also improved over FFR-CT alone (both p < 0.05). It also had improved specificity compared with FFR-CT or CTP alone (p < 0.01). A strong correlation between CTP-FFR and invasive FFR values was found on per-vessel analysis (Pearson’s correlation coefficient 0.89). The specificity of CTP-FFR was higher in the severe calcification group than in the low calcification group (p < 0.001). Conclusions: A novel CTP-FFR model has promising value to detect myocardial ischemia in CAD, particularly in mild-to-moderate stenotic lesions.
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Affiliation(s)
- Xuelian Gao
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Rui Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth 6845, Australia
| | - Hongkai Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Kairui Bo
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Xiaofei Xue
- School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Junjie Yang
- Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
- Correspondence: (J.Y.); (L.X.)
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Correspondence: (J.Y.); (L.X.)
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Yang F, Shi K, Chen Y, Yin Y, Zhao Y, Zhang T. Effect of 320-Row Computed Tomography Acquisition Technology on Coronary Computed Tomography Angiography-Derived Fractional Flow Reserve Based on Machine Learning: Systolic and Diastolic Scan Acquisition. J Comput Assist Tomogr 2023; 47:205-211. [PMID: 36877750 DOI: 10.1097/rct.0000000000001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND The aim of the study is to investigate the performance of coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) in the same patient evaluated by different systolic and diastolic scans, aiming to explore whether 320-slice CT scanning acquisition protocol has an impact on CT-FFR value. METHODS One hundred forty-six patients with suspected coronary artery stenosis who underwent CCTA examination were included into the study. The prospective electrocardiogram gated trigger sequence scan was performed and electrocardiogram editors selected 2 optimal phases of systolic phase (preset collection trigger at 25% of R-R interval) and diastolic phase (preset collection trigger at 75% of R-R interval) for reconstruction. The lowest CT-FFR value (the CT-FFR value at the distal end of each vessel) and the lesion CT-FFR value (at 2 cm distal to the stenosis) after coronary artery stenosis were calculated for each vessel. The difference of CT-FFR values between the 2 scanning techniques was compared using paired Wilcoxon signed-rank test. Pearson correlation value and Bland-Altman were performed to evaluate the consistency of CT-FFR values. RESULTS A total of 366 coronary arteries from the remaining 122 patients were analyzed. There was no significant difference regarding the lowest CT-FFR values between systole phase and diastole phase across all vessels. In addition, there was no significant difference in the lesion CT-FFR value after coronary artery stenosis between systole phase and diastole phase across all vessels. The CT-FFR value between the 2 reconstruction techniques had excellent correlation and minimal bias in all groups. The correlation coefficient of the lesion CT-FFR values for left anterior descending branch, left circumflex branch, and right coronary artery were 0.86, 0.84, and 0.76, respectively. CONCLUSIONS Coronary computed tomography angiography-derived fractional flow reserve based on artificial intelligence deep learning neural network has stable performance, is not affected by the acquisition phase technology of 320-slice CT scan, and has high consistency with the evaluation of hemodynamics after coronary artery stenosis.
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Affiliation(s)
- Fengfeng Yang
- From the Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin
| | - Ke Shi
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin
| | | | | | - Yang Zhao
- From the Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin
| | - Tong Zhang
- Department of Radiology, The Fourth Affiliated Hospital, Harbin Medical University, Harbin
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Zhao X, Meng L, Tong X, Xu X, Wang W, Miao Z, Mo D. A novel computational fluid dynamic method and validation for assessing distal cerebrovascular microcirculatory resistance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 230:107338. [PMID: 36640605 DOI: 10.1016/j.cmpb.2023.107338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The non-invasive assessment of microcirculatory resistance could improve the treatment of cerebrovascular stenosis. This study aimed to validate a novel computational strategy for determining the reference value of microcirculatory resistance in patients with cerebrovascular stenosis. METHODS We reconstructed a patient-specific 3-dimensional model of the extracranial-intracranial arteries. A computational strategy incorporating patient-specific pressure-wire measurements was developed to estimate the blood flow rate and microcirculatory resistance. Throughout the computational fluid dynamics (CFD) simulation, the boundary conditions were adjusted according to the developed algorithm. Pearson correlation and Bland-Altman analyses were used to quantify the correlation and agreement between CFD calculations and transcranial Doppler (TCD) assessment. RESULTS A strong correlation was found between the CFD-based and invasive distal pressure measurements (P<0.0001). Meanwhile, the CFD and TCD-based flow measurements were highly correlated (r = 0.853; P = 0.001). Furthermore, there was a correlation between the mean velocity measured by CFD and the mean velocity measured by TCD (r = 0.777; P<0.001). Good agreement was observed between the mass flow by CFD simulation and volumetric flow by TCD (P = 0.0266, mean difference: -0.7814 mmHg, limits of agreement, -4.0905 - 2.5276). However, the mean velocities from CFD simulation were in less agreement with those from the TCD assessment (P = 0.3992, mean difference, -0.0485; limits of agreement, -0.6141 - 0.5170). Results of the CFD simulation indicate that the flow resistance varies greatly between individuals. CONCLUSIONS The computational strategy of incorporating patient-specific pressure-wire measurements may serve as an effective approach to evaluate the actual reference values of microcirculatory resistance. In addition, an individualized assessment of non-invasive flow resistance is necessary for the accurate determination of non-invasive cerebrovascular pressure.
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Affiliation(s)
- Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China.
| | | | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Ferdows M, Hoque KE, Bangalee MZI, Xenos MA. Wall shear stress indicators influence the regular hemodynamic conditions in coronary main arterial diseases: cardiovascular abnormalities. Comput Methods Biomech Biomed Engin 2023; 26:235-248. [PMID: 35587791 DOI: 10.1080/10255842.2022.2054660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Computational hemodynamic (CH) characteristics play a central role in the onset and expansion of atherosclerotic plaques in the coronary main arteries. This study has explored the effects of hemodynamic properties especially coronary arterial wall tangential stresses on various healthy and diseased patient-based coronary artery models based on coronary computed tomography angiography (CCTA) imaging. The key components of the work are the CCTA image acquisition, accurate three-dimensional (3 D) model segmentation, reconstruction, appropriate grid generation, CH simulations, and analysis of the results by using open-source techniques. The CH simulation results have produced hemodynamic variables, including velocity magnitude (VM), mean arterial pressure difference, wall shear stress (WSS), time-averaged WSS (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and finally, computational fractional flow reserve (cFFR), that allow the pathophysiological conditions in patient-based coronary models. The VM, mean pressure difference, and WSS indices have yielded consistent simulation results for predicting the severity conditions of coronary diseases. We have compared our cFFR results with the published results and observed that the WSS indices were a good alternative approach for measuring the severity of coronary lesions. The CH results allow a medical expert to estimate the severity of a lumen area and stenosis physiological blood flow conditions in a non-invasive way.
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Affiliation(s)
- M Ferdows
- Research Group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
| | - K E Hoque
- Research Group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
| | - M Z I Bangalee
- Research Group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
| | - M A Xenos
- Department of Mathematics, Section of Applied and Computational Mathematics, University of Ioannina, Ioannina, Greece
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Safian RD. Computed Tomography-Derived Physiology Assessment: State-of-the-Art Review. Interv Cardiol Clin 2023; 12:95-117. [PMID: 36372465 DOI: 10.1016/j.iccl.2022.09.009] [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
Coronary computed tomography angiography (CCTA) and CCTA-derived fractional flow reserve (FFRCT) are the best non-invasive techniques to assess coronary artery disease (CAD) and myocardial ischemia. Advances in these technologies allow a paradigm shift to the use of CCTA and FFRCT for advanced plaque characterization and planning myocardial revascularization.
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Affiliation(s)
- Robert D Safian
- The Lucia Zurkowski Endowed Chair, Center for Innovation & Research in Cardiovascular Diseases (CIRC), Department of Cardiovascular Medicine, Oakland University, William Beaumont School of Medicine, William Beaumont University Hospital, Royal Oak, MI 48073, USA.
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39
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Zu ZY, Xu PP, Chen Q, Chen YC, Qi JC, Tang CX, Zhou CS, Xu C, Sun XJ, Lu MJ, Lu GM, Wang YN, Xu Y, Zhang LJ. The prognostic value of CT-derived fractional flow reserve in coronary artery bypass graft: a retrospective multicenter study. Eur Radiol 2022; 33:3029-3040. [PMID: 36576550 DOI: 10.1007/s00330-022-09353-7] [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] [Received: 06/09/2022] [Revised: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate the predictive value of CT-derived fractional flow reserve (FFRCT) in anastomosis occlusion after coronary artery bypass graft (CABG) surgery. METHODS Patients undergoing CABG with both pre- and post-operative coronary computed tomographic angiography (CCTA) were retrospectively included. Preoperative CCTA studies were used to evaluate anatomical and FFRCT information of target vessels. A diameter stenosis (DS) ≥ 70% or left main > 50% was considered to be anatomically severe, while FFRCT value ≤ 0.80 be functionally significant. The primary endpoint was anastomosis occlusion evaluated on post-operative CCTA during follow-up. Predictors of anastomosis occlusion were assessed by the multivariate binary logistic regression with generalized estimating equations. RESULTS A total of 270 anastomoses were identified in 88 enrolled patients. Forty-one anastomoses from 30 patients exhibited occlusion during a follow-up of 15.3 months after CABG. The occluded group had significantly increased prevalence of non-severe DS (58.5% vs. 40.2%; p = 0.023) and non-significant FFRCT (48.8% vs. 10.0%; p < 0.001). Multivariable analysis indicated FFRCT ≤ 0.80 (odds ratio [OR]: 0.10, 95% CI: 0.03-0.33; p < 0.001) and older age (OR: 0.92, 95% CI: 0.87-0.97; p = 0.001) were predictors for bypass patency during follow-up, while myocardial infarction history and anastomosis to a local lesion or bifurcation (all p value < 0.05) were predictors of occlusion. Adding FFRCT into the model based on the clinical and anatomical predictors had an improved AUC of 0.848 (p = 0.005). CONCLUSIONS FFRCT ≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. Preoperative judgment of the hemodynamic significance may improve the CABG surgery strategy and reduce graft failure. KEY POINTS • FFRCT ≤ 0.80 was associated with a significant risk reduction of anastomosis occlusion after CABG. • The addition of FFRCT into the integrated model including clinical (age and history of myocardial infarction) and anatomical CCTA indicators (local lesion and bifurcation) significantly improved the model performance with an AUC of 0.848 (p = 0.005). • Preoperative judgment of the hemodynamic significance may help improve the decision-making and surgery planning in patients indicated for CABG and significantly reduce graft failure, without an extra radiation exposure and risk of invasive procedure.
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Affiliation(s)
- Zi Yue Zu
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Peng Peng Xu
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Qian Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yan Chun Chen
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jian Chen Qi
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chun Xiang Tang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Chang Sheng Zhou
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Cheng Xu
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Xin Jie Sun
- Department of Radiology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Jie Lu
- Shanghai Jiao Tong University, Shanghai, China
| | - Guang Ming Lu
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Yi Ning Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yi Xu
- Department of Radiology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Long Jiang Zhang
- Department of Radiology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China.
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Takahashi K, Morota T, Ishii Y. A novel transit-time flow metric, diastolic resistance index, detects subcritical anastomotic stenosis in coronary artery bypass grafting. JTCVS Tech 2022; 17:94-103. [PMID: 36820345 PMCID: PMC9938392 DOI: 10.1016/j.xjtc.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
Objective Transit time flow measurement (TTFM) can detect critical anastomotic stenosis during coronary artery bypass grafting. However, the identification of subcritical stenosis remains challenging. We hypothesized that diastolic resistance index (DRI), a novel TTFM metric, is more effective in evaluating subcritical stenosis than the currently available TTFM metrics. DRI is used to measure changes in the diastolic versus systolic resistance of distal anastomosis. Methods A total of 123 coronary bypass anastomoses in 35 patients were prospectively analyzed. During coronary artery bypass grafting, the mean graft flow (Qmean), pulsatility index, and diastolic filling were obtained. DRI was calculated using the intraoperative recordings of TTFM and arterial pressure. Postoperatively, stenosis of anastomoses was categorized into successful (<50%), subcritical (50%-74%), and critical (≥75%) via multidetector computed tomography scan. Results In total, 93 (76%), 13 (10%), and 17 (14%) anastomoses were graded as successful, subcritical, and critical, respectively. DRI and diastolic filling could distinguish subcritical from successful anastomoses (P < .01 and < .01, respectively), whereas Qmean and pulsatility index could not (P = .12 and .39, respectively). The receiver operating characteristic curves were established to evaluate the diagnostic ability for detecting ≥50% stenosis. In left anterior descending artery grafting (n = 55), DRI had the highest area under the curve (0.91), followed by diastolic filling (0.87), Qmean (0.74), and pulsatility index (0.65). Conclusions DRI and diastolic filling had a reliable diagnostic ability for detecting ≥50% stenosis during coronary artery bypass grafting. In left anterior descending artery grafting, DRI had a more satisfactory detection capability than other TTFM metrics.
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Key Words
- AUC, area under the curve
- CABG, coronary artery bypass grafting
- CCT, coronary computed tomography
- DF, diastolic filling
- DRI, diastolic resistance index
- FFR, fractional flow reserve
- ITA, internal thoracic artery
- LAD, left anterior descending artery
- LCx, left circumflex artery
- PBS, posterior balanced sensitivity
- PI, pulsatility index
- Qmean, mean graft flow
- RCA, right coronary artery
- ROC, receiver operator characteristic
- SVG, saphenous vein graft
- TTFM, transit-time flow measurement
- anastomotic stenosis
- coronary artery bypass grafting
- intraoperative graft evaluation
- transit-time flow measurement
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Affiliation(s)
- Kenichiro Takahashi
- Address for reprints: Kenichiro Takahashi, MD, PhD, Department of Cardiovascular Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
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Zhang LJ, Tang C, Xu P, Guo B, Zhou F, Xue Y, Zhang J, Zheng M, Xu L, Hou Y, Lu B, Guo Y, Cheng J, Liang C, Song B, Zhang H, Hong N, Wang P, Chen M, Xu K, Liu S, Jin Z, Lu G. Coronary Computed Tomography Angiography-derived Fractional Flow Reserve: An Expert Consensus Document of Chinese Society of Radiology. J Thorac Imaging 2022; 37:385-400. [PMID: 36162081 DOI: 10.1097/rti.0000000000000679] [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: 12/26/2022]
Abstract
Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the state-of-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.
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Affiliation(s)
- Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Chunxiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Pengpeng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Bangjun Guo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University-Xi'an
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University
| | - Bin Lu
- Department of Radiology, State Key Laboratory and National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province
| | - Bin Song
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital
| | - Peijun Wang
- Department of Radiology, Tongji Hospital of Tongji University School of Medicine
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Ke Xu
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Shiyuan Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Zhengyu Jin
- Department of Medical Imaging and Nuclear Medicine, Changzheng Hospital of Naval Medical University, Shanghai
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
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Tang CX, Zhou Z, Zhang JY, Xu L, Lv B, Jiang Zhang L. Cardiovascular Imaging in China: Yesterday, Today, and Tomorrow. J Thorac Imaging 2022; 37:355-365. [PMID: 36162066 DOI: 10.1097/rti.0000000000000678] [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: 11/26/2022]
Abstract
The high prevalence and mortality of cardiovascular diseases in China's large population has increased the use of cardiovascular imaging for the assessment of conditions in recent years. In this study, we review the past 20 years of cardiovascular imaging in China, the increasingly important role played by cardiovascular computed tomography in coronary artery disease and pulmonary embolism assessment, magnetic resonance imaging's use for cardiomyopathy assessment, the development and application of artificial intelligence in cardiovascular imaging, and the future of Chinese cardiovascular imaging.
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Affiliation(s)
- Chun Xiang Tang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Zhen Zhou
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Jia Yin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Bin Lv
- Department of Radiology, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences
- State Key Laboratory and National Center for Cardiovascular Diseases, Beijing
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
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Zhang LJ, Yang J, Jin Z, Lu GM. Cardiothoracic Imaging in China: Opening Up New Horizons. J Thorac Imaging 2022; 37:353-354. [PMID: 36306266 PMCID: PMC9592163 DOI: 10.1097/rti.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Junjie Yang
- Senior Department of Cardiology, Sixth Medical Center of PLA General Hospital
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guang Ming Lu
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
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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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Lv L, Li H, Wu Z, Zeng W, Hua P, Yang S. An artificial intelligence-based platform for automatically estimating time-averaged wall shear stress in the ascending aorta. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2022; 3:525-534. [PMID: 36710907 PMCID: PMC9779925 DOI: 10.1093/ehjdh/ztac058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
Abstract
Aims Aortopathies are a series of disorders requiring multiple indicators to assess risk. Time-averaged wall shear stress (TAWSS) is currently considered as the primary indicator of aortopathies progression, which can only be calculated by Computational Fluid Dynamics (CFD). However, CFD's complexity and high computational cost, greatly limit its application. The study aimed to construct a deep learning platform which could accurately estimate TAWSS in ascending aorta. Methods and results A total of 154 patients who had thoracic computed tomography angiography were included and randomly divided into two parts: training set (90%, n = 139) and testing set (10%, n = 15). TAWSS were calculated via CFD. The artificial intelligence (AI)-based model was trained and assessed using the dice coefficient (DC), normalized mean absolute error (NMAE), and root mean square error (RMSE). Our AI platform brought into correspondence with the manual segmentation (DC = 0.86) and the CFD findings (NMAE, 7.8773% ± 4.7144%; RMSE, 0.0098 ± 0.0097), while saving 12000-fold computational cost. Conclusion The high-efficiency and robust AI platform can automatically estimate value and distribution of TAWSS in ascending aorta, which may be suitable for clinical applications and provide potential ideas for CFD-based problem solving.
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Affiliation(s)
| | | | - Zonglv Wu
- Department of Cardio-Vascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yan Jiang West Road, 510120 Guangzhou, China,Department of Cardiac Surgery, Guangzhou Women and Children's Medical Center, No. 9 Jinsui Road, 510623 Guangzhou, China
| | - Weike Zeng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, 510120 Guangzhou, China
| | - Ping Hua
- Corresponding author. Tel: +86 13 609716875, Fax: +86 20 81332199, (P.H.); Tel: +86 13926168990, Fax: +86 20 81332199, (S.R.)
| | - Songran Yang
- Corresponding author. Tel: +86 13 609716875, Fax: +86 20 81332199, (P.H.); Tel: +86 13926168990, Fax: +86 20 81332199, (S.R.)
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Jin X, Jin X, Wu X, Chen L, Wang T, Zang W. Distribution of FFRCT in single obstructive coronary stenosis and predictors for major adverse cardiac events: a propensity score matching study. BMC Med Imaging 2022; 22:59. [PMID: 35361151 PMCID: PMC8973531 DOI: 10.1186/s12880-022-00783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background Fractional flow reserve derived from computed tomography (FFRCT) has been demonstrated to improve identification of lesion-specific ischemia significantly compared with coronary computed tomography angiography (CCTA). It remains unclear whether the distribution of FFRCT values in obstructive stenosis between patients who received percutaneous coronary intervention (PCI) or not in routine clinical practice, as well as its association with clinical outcome. This study aims to reveal the distribution of FFRCT value in patients with single obstructive coronary artery stenosis and explored the independent factors for predicting major adverse cardiac events (MACE). Methods This was a retrospective study of adults with non-ST-segment elevation acute coronary syndrome undergoing FFRCT assessment by using CCTA data from January 1, 2016 to December 31, 2020. Propensity score matching (PSM) method was used to account for patient selection bias. The risk factors for predicting MACE were evaluated by a Cox proportional hazards regression analysis. Results Overall, 655 patients with single obstructive (≥ 50%) stenosis shown on CCTA were enrolled and divided into PCI group (279 cases) and conservative group (376 cases) according to treatment strategy. The PSM cohort analysis demonstrated that the difference in history of unstable angina, Canadian Cardiovascular Society Class (CCSC) and FFRCT between PCI group (188 cases) and conservative group (315 cases) was statistically significant, with all P values < 0.05, while the median follow-up time between them was not statistically significant (24 months vs. 22.5 months, P = 0.912). The incidence of MACE in PCI group and conservative group were 14.9% (28/188) and 23.5% (74/315) respectively, P = 0.020. Multivariate analysis of Cox proportional hazards regression revealed that history of unstable angina (adjusted odds ratio (adjOR), 3.165; 95% confidence interval (CI), 2.087–4.800; P < 0.001), FFRCT ≤ 0.8 (OR, 1.632;95% CI 1.095–2.431; P = 0.016), and PCI therapy (OR 0.481; 95% CI 0.305–0.758) were the independent factors for MACE. Conclusions History of unstable angina and FFRCT value of ≤ 0.8 were the independent risk factors for MACE, while PCI therapy was the independent protective factor for MACE.
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Affiliation(s)
- Xianglan Jin
- Department of Cardiac Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai, 200072, China
| | - Xiangyu Jin
- Hainan College of Economics and Business, Haikou, 571127, Hainan, China
| | - Xiaoyun Wu
- Department of Cardiac Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai, 200072, China
| | - Luguang Chen
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
| | - Tiegong Wang
- Department of Radiology, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
| | - Wangfu Zang
- Department of Cardiac Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301 Yanchang Middle Road, Shanghai, 200072, China.
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Functional CAD-RADS using FFR CT on therapeutic management and prognosis in patients with coronary artery disease. Eur Radiol 2022; 32:5210-5221. [PMID: 35258672 DOI: 10.1007/s00330-022-08618-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To propose a novel functional Coronary Artery Disease-Reporting and Data System (CAD-RADS) category system integrated with coronary CT angiography (CCTA)-derived fractional flow reserve (FFRCT) and to validate its effect on therapeutic decision and prognosis in patients with coronary artery disease (CAD). METHODS Firstly, we proposed a novel functional CAD-RADS and evaluated the performance of functional CAD-RADS for guiding treatment strategies with actual clinical treatment as a reference standard in a retrospective multicenter cohort with CCTA and invasive FFR performed in all patients (n = 466). Net reclassification improvement (NRI) of functional CAD-RADS over anatomical CAD-RADS was calculated. Secondly, the prognostic value of functional CAD-RADS in a prospective two-arm cohort (566 [FFRCT arm] vs. 567 [CCTA arm]) was calculated, after a 1-year follow-up, functional CAD-RADS in FFRCT arm (n = 513) and anatomical CAD-RADS in CCTA arm (n = 511) to determine patients at risk of adverse outcomes were compared with a Cox hazard proportional model. RESULTS Functional CAD-RADS demonstrated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) and comparable performance to FFR (AUC: 0.828 vs. 0.848, p = 0.253) in guiding therapeutic decisions. Functional CAD-RADS resulted in the revision of management plan as determined by anatomical CAD-RADS in 30.0% of patients (n = 140) (NRI = 0.369, p < 0.001). Functional CAD-RADS was an independent predictor for 1-year outcomes with indexes of concordance of 0.795 and the corresponding value was 0.751 in anatomical CAD-RADS. CONCLUSION The novel functional CAD-RADS gained incremental value in guiding therapeutic decision-making compared with anatomical CAD-RADS and comparable power in 1-year prognosis with anatomical CAD-RADS in a real-world scenario. KEY POINTS • The novel functional CAD-RADS category system with FFRCT integrated into the anatomical CAD-RADS categories was originally proposed. • The novel functional CAD-RADS category system was validated superior value over anatomical CAD-RADS (AUC: 0.828 vs. 0.681, p < 0.001) in guiding therapeutic decisions and revised management plan in 30.0% of patients as determined by anatomical CAD-RADS (net reclassification improvement index = 0.369, p < 0.001). • Functional CAD-RADS was an independent predictor with an index of concordance of 0.795 and 0.751 in anatomical CAD-RADS for 1-year prognosis of adverse outcomes.
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LI NA, LIU JINCHENG, LI BAO, BAI LAN, FENG YILI, LIU JIAN, ZHANG LIYUAN, YANG HAISHENG, LIU YOUJUN. PERSONALIZED FLOW DIVISION METHOD BASED ON THE LEFT-RIGHT CORONARY CROSS-SECTIONAL AREA. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This paper proposes a personalized method to estimate blood flow distribution based on the cross-sectional area of the left-right coronary artery openings. According to the cross-sectional area of the left-right coronary artery in 30 cases, a personalized flow distribution model was derived. A 0D/3D geometric multiscale model was used for the numerical simulation of FFR. To evaluate the accuracy of the cross-sectional area method, invasive FFR was used as the standard. The diagnostic efficiency of the proposed method was verified through the simulation results of the volume and the fixed ratio methods. The flow of the left-right coronary artery was proportional to the 3/4 power of the cross-sectional area. The 95% LOA between the cross-sectional area method, volume method, fixed ratio method and FFR were [Formula: see text]0.06 ([[Formula: see text]0.22, 0.10]), [Formula: see text]0.03 ([[Formula: see text]0.35, 0.28]), and [Formula: see text]0.05 ([[Formula: see text]0.30, 0.20]), the accuracy values were 94.44%, 77.78%, and 77.78%, respectively. Flow distribution based on the cross-sectional area represents the supply and demand relationship of the myocardium. The flow of the left-right coronary arteries is proportional to the 3/4 exponent of the cross-sectional area, which affects the accuracy of FFRCT by affecting the exit boundary conditions of the 0D/3D model.
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Affiliation(s)
- NA LI
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - JINCHENG LIU
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - BAO LI
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - LAN BAI
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - YILI FENG
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - JIAN LIU
- Peking University People’s Hospital, Beijing P. R. China
| | - LIYUAN ZHANG
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - HAISHENG YANG
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
| | - YOUJUN LIU
- College of Life Science and Chemistry Faculty of Environment and Life, Beijing University of Technology, Beijing, P. R. China
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Nozaki YO, Fujimoto S, Kawaguchi YO, Aoshima C, Kamo Y, Sato H, Kudo H, Takamura K, Kudo A, Takahashi D, Hiki M, Dohi T, Tomizawa N, Kumamaru KK, Aoki S, Minamino T. Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve. J Cardiol 2022; 80:14-21. [DOI: 10.1016/j.jjcc.2022.02.019] [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: 01/07/2022] [Revised: 02/14/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
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Dai X, Lu Z, Yu Y, Yu L, Xu H, Zhang J. The use of lesion-specific calcium morphology to guide the appropriate use of dynamic CT myocardial perfusion imaging and CT fractional flow reserve. Quant Imaging Med Surg 2022; 12:1257-1269. [PMID: 35111621 DOI: 10.21037/qims-21-491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/18/2021] [Indexed: 12/28/2022]
Abstract
Background We aimed to optimize the diagnostic strategy for dynamic computed tomography myocardial perfusion imaging (CT-MPI) and CT fractional flow reserve (CT-FFR) in the evaluation of coronary artery disease (CAD). Methods Patients who had undergone coronary CT angiography (CCTA) + dynamic CT-MPI and invasive coronary angiography (ICA)/FFR within a 4-week period were retrospectively included. Lesion-specific characteristics were recorded, and multivariate logistic regression was performed to determine the predictors of mismatched CT findings with ICA results. An optimized diagnostic strategy was proposed based on the diagnostic performance of dynamic CT-MPI and CT-FFR compared with ICA/FFR. A net reclassification index (NRI) was calculated to determine the incremental discriminatory power of optimized CT-FFR + dynamic CT-MPI strategy compared to CT-FFR alone. Results The study included 180 patients with 229 diseased vessels. For CT-FFR, a calcified lesion with a calcium arc >180° was the only independent predictor for misdiagnosis of ischemic coronary stenosis (odds ratio =2.367; P=0.002). For noncalcified lesions and calcified lesions with a calcium arc ≤180°, the sensitivity and negative predictive value (NPV) of CT-FFR were similar to those of CT-MPI (all P values >0.05), whereas the specificity and positive predictive value (PPV) of CT-FFR were significantly lower (all P values <0.05). For calcified lesions with a calcium arc >180°, the specificity, NPV, and PPV of CT-FFR were inferior to those of CT-MPI (21.2% vs. 100%, 58.3% vs. 86.8%, and 62.9% vs. 100%, respectively; all P values <0.05). As guided by lesion-specific calcium morphology, an optimized CT-FFR + dynamic CT-MPI strategy (NRI =0.2; P=0.004) would have resulted in a 27.0% and 33.9% reduction of radiation dose and contrast medium consumption, respectively, and 25.3% of patients would have avoided unnecessary invasive tests. Conclusions The diagnostic performance of CT-FFR was significantly inferior in lesions with a calcium arc >180°. Lesion-specific calcium morphology is the preferred parameter to guide the appropriate use of CT-based functional assessment.
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Affiliation(s)
- Xu Dai
- Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Zhigang Lu
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yarong Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lihua Yu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Xu
- Department of Cardiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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