1
|
Li C, Hu Y, Jiang J, Dong L, Sun Y, Tang L, Du C, Yin D, Jiang W, Leng X, Jiang F, Pan Y, Jiang X, Zhou Z, Koo BK, Xiang J, Wang J. Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography: The ACCURATE-CT Study. JACC Cardiovasc Interv 2024:S1936-8798(24)00952-X. [PMID: 39177553 DOI: 10.1016/j.jcin.2024.06.027] [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: 04/30/2024] [Revised: 06/19/2024] [Accepted: 06/24/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND ArteryFlow Technology (AccuFFRct) is a novel noninvasive method for calculating fractional flow reserve (FFR) from coronary computed tomography angiography (CCTA). The accuracy of AccuFFRct has not been adequately assessed. OBJECTIVES This study sought to evaluate the diagnostic performance of AccuFFRct in detecting lesion-specific ischemia. METHODS This prospective study enrolled 339 patients with 404 vessels. CCTA-derived FFR was calculated using an on-site computational fluid dynamics-based method and compared with invasive FFR. The performance of AccuFFRct was comprehensively analyzed in all lesions and subgroups, including "gray zone" lesions, various lesion classifications, clinical presentations, stenosis severities, and lesion locations. RESULTS Using FFR ≤0.80 as a reference standard, the overall diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for AccuFFRct were 90.6% (95% CI: 87.3%-93.3%), 90.9% (95% CI: 85.1%-94.9%), 90.4% (95% CI: 86.1%-93.8%), 85.3% (95% CI: 79.8%-89.5%), and 94.2% (95% CI: 90.8%-96.4%), respectively. Good correlation and agreement were found between the computed AccuFFRct and measured FFR. AccuFFRct showed superior discrimination ability to CCTA (AUC: 0.93 [95% CI: 0.89-0.95] vs 0.77 [95% CI: 0.72-0.81]; P < 0.001) and quantitative coronary angiography (AUC: 0.93 [95% CI: 0.89-0.95] vs 0.89 [95% CI: 0.85-0.92]; P = 0.048) for identifying functionally significant stenosis. Notably, AccuFFRct maintained high diagnostic accuracy across the spectrum of lesion classifications, clinical presentations, stenosis severities, lesion locations, and in the gray zone. Furthermore, in the cohort with ≥70% stenosis, AccuFFRct could significantly reduce the rate of un-necessary invasive tests (33.1% vs 6.6%; P < 0.001). CONCLUSIONS The study confirms the potential of AccuFFRct as a noninvasive alternative to invasive FFR for detecting ischemia in coronary artery disease and to risk stratify patients. The results highlight AccuFFRct's robust diagnostic ability across a wide range of lesion classifications, clinical presentations, stenosis severities, lesion locations, and in the gray zone. (Diagnostic Performance of Fractional Flow Reserve Derived From Coronary CT Angiography [ACCURATE-CT]; NCT04426396).
Collapse
Affiliation(s)
- Changling Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yumeng Hu
- ArteryFlow Research and Development Center for Intelligent Diagnosis and Treatment of Cardiovascular and Cerebrovascular Diseases, ArteryFlow Technology Co, Ltd, Hangzhou, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liang Dong
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yong Sun
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Lijiang Tang
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Changqing Du
- Department of Cardiology, Zhejiang Hospital, Hangzhou, China
| | - Da Yin
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital, Shenzhen, China
| | - Wenbing Jiang
- Department of Cardiology, The Third Clinical Institute Affiliated to Wenzhou Medical University, Wenzhou, China
| | - Xiaochang Leng
- ArteryFlow Research and Development Center for Intelligent Diagnosis and Treatment of Cardiovascular and Cerebrovascular Diseases, ArteryFlow Technology Co, Ltd, Hangzhou, China
| | - Fan Jiang
- Department of Cardiology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, China
| | - Yibin Pan
- Department of Cardiology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Xuejun Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhong Zhou
- Department of Cardiology, The Affiliated Hospital of Medical School, Ningbo University, Ningbo, China
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jianping Xiang
- ArteryFlow Research and Development Center for Intelligent Diagnosis and Treatment of Cardiovascular and Cerebrovascular Diseases, ArteryFlow Technology Co, Ltd, Hangzhou, China.
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Agujetas R, Ferrera C, González-Fernández R, Nogales-Asensio JM, Fernández-Tena A. Influence of the position of the distal pressure measurement point on the Fractional Flow Reserve using in-silico simulations. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
4
|
Cai Y, Li Z. Mathematical modeling of plaque progression and associated microenvironment: How far from predicting the fate of atherosclerosis? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106435. [PMID: 34619601 DOI: 10.1016/j.cmpb.2021.106435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Mathematical modeling contributes to pathophysiological research of atherosclerosis by helping to elucidate mechanisms and by providing quantitative predictions that can be validated. In turn, the complexity of atherosclerosis is well suited to quantitative approaches as it provides challenges and opportunities for new developments of modeling. In this review, we summarize the current 'state of the art' on the mathematical modeling of the effects of biomechanical factors and microenvironmental factors on the plaque progression, and its potential help in prediction of plaque development. We begin with models that describe the biomechanical environment inside and outside the plaque and its influence on its growth and rupture. We then discuss mathematical models that describe the dynamic evolution of plaque microenvironmental factors, such as lipid deposition, inflammation, smooth muscle cells migration and intraplaque hemorrhage, followed by studies on plaque growth and progression using these modelling approaches. Moreover, we present several key questions for future research. Mathematical models can complement experimental and clinical studies, but also challenge current paradigms, redefine our understanding of mechanisms driving plaque vulnerability and propose future potential direction in therapy for cardiovascular disease.
Collapse
Affiliation(s)
- Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhiyong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4001, Australia
| |
Collapse
|
5
|
Luo Y, Mao M, Xiang R, Han B, Chang J, Zuo Z, Wu F, Ma K. Diagnostic performance of computed tomography-based fraction flow reserve in identifying myocardial ischemia caused by coronary artery stenosis: A meta-analysis. Hellenic J Cardiol 2021; 63:1-7. [PMID: 34107338 DOI: 10.1016/j.hjc.2021.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND As a new noninvasive diagnostic technique, computed tomography (CT)-based fraction flow reserve (FFR) has been used to identify hemodynamically significant coronary artery stenosis. This meta-analysis used invasive FFR as the standard to evaluate the diagnostic performance of FFRCT. METHODS We searched the PubMed, Cochrane library, and EMBASE for articles published between January 2009 and January 2021. The synthesized sensitivity and specificity of invasive FFR and FFRCT were analyzed at both the patient and vessel levels. We generated a summary receiver operating characteristic curve (SROC) and then calculated the area under the curve (AUC). RESULTS We included a total of 23 studies, including 2,178 patients and 3,029 vessels or lesions. Analysis at each patient level demonstrated a synthesized sensitivity of 88%, specificity of 79%, LR+ of 4.16, LR-of 0.15, and AUC of 0.89 for FFRCT. Analysis at the level of each vessel or lesion showed a synthesized sensitivity of 85%, specificity of 81%, LR+ of 4.44, LR-of 0.19, and AUC of 0.87 for FFRCT. CONCLUSION Our research reveals that FFRCT has high diagnostic performance in patients with coronary artery stenosis, regardless of whether it is at the patient level or the vessel level.
Collapse
Affiliation(s)
- Yue Luo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Min Mao
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Rui Xiang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Baoru Han
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jing Chang
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Zhong Zuo
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Fan Wu
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kanghua Ma
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
| |
Collapse
|
6
|
Clinical application of computed tomography angiography and fractional flow reserve computed tomography in patients with coronary artery disease: A meta-analysis based on pre- and post-test probability. Eur J Radiol 2021; 139:109712. [PMID: 33865062 DOI: 10.1016/j.ejrad.2021.109712] [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: 01/13/2021] [Revised: 03/22/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the diagnostic role of coronary computed tomography angiography (CCTA) and fractional flow reserve computed tomography (FFRCT) in confirming or excluding ischemic coronary artery disease (CAD) and to provide a rational use of CCTA and FFRCT in different pre-test probability (PTP) of CAD. METHODS We searched the electronic databases from the earliest relevant literature to July 2020 comparing FFRCT or CCTA with FFR. The bivariate random-effects models and Bayes' theorem were used to investigate the diagnostic performance of CCTA and FFRCT with the sensitivity, specificity, pre- and post-test probability. RESULTS Fifty-three articles with 4817 patients and 7026 vessels finally met our inclusion criteria. At the patient level, the sensitivity and specificity of CCTA were (0.94, 0.89-0.97), and (0.50, 0.43-0.58), respectively. For FFRCT, the sensitivity and specificity were (0.90, 0.87-0.93) and (0.81, 0.73-0.87). CCTA or FFRCT could increase the post-test probability to >85 % in patients with a PTP > 74.9 % or 54.5 %; CCTA or FFRCT could decrease the post-test probability to <15 % in patients with a pre-test probability <61.3 % or 59.3 %. CONCLUSIONS In patients with low to intermediate PTP, CCTA is suggested to exclude CAD, while the time-consuming calculation of FFRCT may be unnecessary. If CCTA detects significant or uncertain stenosis with intermediate to high PTP of CAD, further FFRCT is suggested. The advantages of FFRCT for guiding CAD treatment have sufficiently been demonstrated.
Collapse
|
7
|
Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
Collapse
Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| |
Collapse
|
8
|
Peper J, Suchá D, Swaans M, Leiner T. Functional cardiac CT-Going beyond Anatomical Evaluation of Coronary Artery Disease with Cine CT, CT-FFR, CT Perfusion and Machine Learning. Br J Radiol 2020; 93:20200349. [PMID: 32783626 DOI: 10.1259/bjr.20200349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
The aim of this review is to provide an overview of different functional cardiac CT techniques which can be used to supplement assessment of the coronary arteries to establish the significance of coronary artery stenoses. We focus on cine-CT, CT-FFR, CT-myocardial perfusion and how developments in machine learning can supplement these techniques.
Collapse
Affiliation(s)
- Joyce Peper
- Department of Cardiology, St. Antonius Hospital Koekoekslaan 1, Nieuwegein, the Netherlands.,Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Dominika Suchá
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| | - Martin Swaans
- Department of Cardiology, St. Antonius Hospital Koekoekslaan 1, Nieuwegein, the Netherlands
| | - Tim Leiner
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands
| |
Collapse
|
9
|
Hoque KE, Ferdows M, Sawall S, Tzirtzilakis EE. The effect of hemodynamic parameters in patient-based coronary artery models with serial stenoses: normal and hypertension cases. Comput Methods Biomech Biomed Engin 2020; 23:467-475. [DOI: 10.1080/10255842.2020.1737028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- K. E. Hoque
- Research group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
- Department of Arts and Sciences, Faculty of Engineering, Ahsanullah University of Science and Technology, Dhaka, Bangladesh
| | - M. Ferdows
- Research group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
| | - S. Sawall
- X-Ray Imaging and Computed Tomography, German Cancer Research Center, Heidelberg, Germany
| | - E. E. Tzirtzilakis
- Fluid Dynamics & Turbo-machinery Laboratory, Department of Mechanical Engineering, University of the Peloponnese, Patras, Greece
| |
Collapse
|
10
|
Sokolov SY, Volchkov SO, Bessonov IS, Chestukhin VV, Kurlyandskaya GV, Blyakhman FA. Estimation of Blood Flow Velocity in Coronary Arteries Based on the Movement of Radiopaque Agent. PATTERN RECOGNITION AND IMAGE ANALYSIS 2019. [DOI: 10.1134/s1054661819040163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
11
|
Carson JM, Roobottom C, Alcock R, Nithiarasu P. Computational instantaneous wave-free ratio (IFR) for patient-specific coronary artery stenoses using 1D network models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3255. [PMID: 31469943 PMCID: PMC7003475 DOI: 10.1002/cnm.3255] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/22/2019] [Accepted: 08/21/2019] [Indexed: 05/05/2023]
Abstract
In this work, we estimate the diagnostic threshold of the instantaneous wave-free ratio (iFR) through the use of a one-dimensional haemodynamic framework. To this end, we first compared the computed fractional flow reserve (cFFR) predicted from a 1D computational framework with invasive clinical measurements. The framework shows excellent promise and utilises minimal patient data from a cohort of 52 patients with a total of 66 stenoses. The diagnostic accuracy of the cFFR model was 75.76%, with a sensitivity of 71.43%, a specificity of 77.78%, a positive predictive value of 60%, and a negative predictive value of 85.37%. The validated model was then used to estimate the diagnostic threshold of iFR. The model determined a quadratic relationship between cFFR and the ciFR. The iFR diagnostic threshold was determined to be 0.8910 from a receiver operating characteristic curve that is in the range of 0.89 to 0.9 that is normally reported in clinical studies.
Collapse
Affiliation(s)
- Jason M. Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
- HDR UK Wales and Northern IrelandHealth Data Research UKLondonUK
| | - Carl Roobottom
- Derriford Hospital and Peninsula Medical SchoolPlymouth Hospitals NHS TrustPlymouthUK
| | - Robin Alcock
- Derriford Hospital and Peninsula Medical SchoolPlymouth Hospitals NHS TrustPlymouthUK
| | - Perumal Nithiarasu
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
| |
Collapse
|
12
|
Yoshikawa Y, Nakamoto M, Nakamura M, Hoshi T, Yamamoto E, Imai S, Kawase Y, Okubo M, Shiomi H, Kondo T, Matsuo H, Kimura T, Saito N. On-site evaluation of CT-based fractional flow reserve using simple boundary conditions for computational fluid dynamics. Int J Cardiovasc Imaging 2019; 36:337-346. [PMID: 31628575 DOI: 10.1007/s10554-019-01709-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
|
13
|
Carson JM, Pant S, Roobottom C, Alcock R, Javier Blanco P, Alberto Bulant C, Vassilevski Y, Simakov S, Gamilov T, Pryamonosov R, Liang F, Ge X, Liu Y, Nithiarasu P. Non-invasive coronary CT angiography-derived fractional flow reserve: A benchmark study comparing the diagnostic performance of four different computational methodologies. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3235. [PMID: 31315158 PMCID: PMC6851543 DOI: 10.1002/cnm.3235] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 05/05/2023]
Abstract
Non-invasive coronary computed tomography (CT) angiography-derived fractional flow reserve (cFFR) is an emergent approach to determine the functional relevance of obstructive coronary lesions. Its feasibility and diagnostic performance has been reported in several studies. It is unclear if differences in sensitivity and specificity between these studies are due to study design, population, or "computational methodology." We evaluate the diagnostic performance of four different computational workflows for the prediction of cFFR using a limited data set of 10 patients, three based on reduced-order modelling and one based on a 3D rigid-wall model. The results for three of these methodologies yield similar accuracy of 6.5% to 10.5% mean absolute difference between computed and measured FFR. The main aspects of modelling which affected cFFR estimation were choice of inlet and outlet boundary conditions and estimation of flow distribution in the coronary network. One of the reduced-order models showed the lowest overall deviation from the clinical FFR measurements, indicating that reduced-order models are capable of a similar level of accuracy to a 3D model. In addition, this reduced-order model did not include a lumped pressure-drop model for a stenosis, which implies that the additional effort of isolating a stenosis and inserting a pressure-drop element in the spatial mesh may not be required for FFR estimation. The present benchmark study is the first of this kind, in which we attempt to homogenize the data required to compute FFR using mathematical models. The clinical data utilised in the cFFR workflows are made publicly available online.
Collapse
Affiliation(s)
- Jason Matthew Carson
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
- Data Science Building, Swansea University Medical SchoolSwansea UniversitySwanseaUK
| | - Sanjay Pant
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
| | - Carl Roobottom
- Derriford Hospital and Peninsula Medical SchoolPlymouth Hospitals NHS TrustPlymouthUK
| | - Robin Alcock
- Derriford Hospital and Peninsula Medical SchoolPlymouth Hospitals NHS TrustPlymouthUK
| | - Pablo Javier Blanco
- Department of Mathematical and Computational MethodsNational Laboratory for Scientific Computing, LNCC/MCTICPetrópolisBrazil
| | | | - Yuri Vassilevski
- Marchuk Institute of Numerical MathematicsRussian Academy of SciencesMoscowRussia
- Laboratory of Human PhysiologyMoscow Institute of Physics and TechnologyMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Sergey Simakov
- Laboratory of Human PhysiologyMoscow Institute of Physics and TechnologyMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Timur Gamilov
- Laboratory of Human PhysiologyMoscow Institute of Physics and TechnologyMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Roman Pryamonosov
- Marchuk Institute of Numerical MathematicsRussian Academy of SciencesMoscowRussia
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
| | - Fuyou Liang
- Institute of Personalized Medicine, Laboratory of Mathematical Modelling in MedicineSechenov UniversityMoscowRussia
- School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Xinyang Ge
- School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Yue Liu
- School of Naval Architecture, Ocean and Civil EngineeringShanghai Jiao Tong UniversityShanghaiChina
| | - Perumal Nithiarasu
- Zienkiewicz Centre for Computational Engineering, College of EngineeringSwansea UniversitySwanseaUK
| |
Collapse
|
14
|
Chen K, Zhang X, Li D, Chen H, Zhang Z, Chen L. A noninvasive and highly sensitive approach for the assessment of coronary collateral circulation by 192-slice third-generation dual-source computed tomography. Medicine (Baltimore) 2019; 98:e17014. [PMID: 31567938 PMCID: PMC6756702 DOI: 10.1097/md.0000000000017014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The coronary collateral circulation (CCC) is an alternative source of blood supply when the original vessels fail to provide sufficient blood. The accurate detection of CCC is critical for the treatment of ischemic heart disease, especially when the stent surgery is not an option. The assessment of minute vessels such as coronary collateral arteries is challenging. The objective of this study was to assess the feasibility of detection and classification of CCC using the192-slice third-generation dual-source computed tomography angiography (192-slice DSCT CTA).Eight hundred patients (450 men and 350 women, mean age: 56 ± 11 years) with complete or subtotal occlusion of at least 1 major coronary artery were enrolled for our study. February 2016 and September 2018, the patient both 192-slice DSCT CTA and conventional coronary angiography (CAG) were performed in all enrolled patients. The interval between two approaches for a given patient was 6.1 ± 3.7 days (Range: 1-15). The diagnostic accuracy of 192-slice DSCT CTA was evaluated by comparing it with that of CAG. The identified CCC was graded according to the Rentrop classification.The prevalence among patients of having at least 1 CCC was 43.8%. The sensitivity for detecting CCC by 192-slice DSCT was 91.7% (95% CI: 88.3% to 94.3%), specificity was 95.5% (95% CI: 93.1% to 97.2%), positive predictive value was 94.3% (95% CI: 91.5% to 96.2%), and negative predictive value was 93.3% (95% CI: 90.9% to 95.3%). Cohen-Kappa analysis showed that the consistency of the correct classification of CCC using CAG and 192-slice DSCT was very high with the kappa coefficient (κ) of 0.94 (95% CI: 0.91-0.96, P value = .01). Additionally, the radiation dose for 192-slice DSCT was as low as 0.42 ± 0.04 mSv (range, 0.35-0.43 mSv).The 192-slice DSCT CTA is a reliable and sensitive non-invasive method for the evaluation of CCC with low radiation doses.
Collapse
Affiliation(s)
- Kebin Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Xiaoge Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Daling Li
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Honglei Chen
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Zhixu Zhang
- Department of Cardiology, Qingdao Chengyang People's Hospital, Qingdao
| | - Lei Chen
- Department of Lab Medicine, Yantai Yuhuangding Hospital, Yantai, Shandong, China
| |
Collapse
|
15
|
Tang CX, Wang YN, Zhou F, Schoepf UJ, Assen MV, Stroud RE, Li JH, Zhang XL, Lu MJ, Zhou CS, Zhang DM, Yi Y, Yan J, Lu GM, Xu L, Zhang LJ. Diagnostic performance of fractional flow reserve derived from coronary CT angiography for detection of lesion-specific ischemia: A multi-center study and meta-analysis. Eur J Radiol 2019; 116:90-97. [DOI: 10.1016/j.ejrad.2019.04.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/03/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
|
16
|
Polanczyk A, Podgorski M, Polanczyk M, Piechota-Polanczyk A, Stefanczyk L, Strzelecki M. A novel vision-based system for quantitative analysis of abdominal aortic aneurysm deformation. Biomed Eng Online 2019; 18:56. [PMID: 31088563 PMCID: PMC6518716 DOI: 10.1186/s12938-019-0681-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In clinical diagnostics, combination of different imaging techniques is applied to assess spatial configuration of the abdominal aortic aneurysm (AAA) and deformation of its wall. As deformation of aneurysm wall is crucial parameter in assessing wall rupture, we aimed to develop and validate a Non-Invasive Vision-Based System (NIVBS) for the analysis of 3D elastic artificial abdominal aortic models. 3D-printed elastic AAA models from four patients were applied for the reconstruction of real hemodynamic. During experiments, the inlet boundary conditions included the injection volume and frequency of pulsation averaged from electrocardiography traces. NIVBS system was equipped with nine cameras placed at a constant distance to record wall movement from 360o angle and a dedicated set of artificial lights providing coherent illumination. Additionally, self-prepared algorithms for image acquisition, processing, segmentation, and contour detection were used to analyze wall deformation. Finally, the shape deformation factor was applied to evaluate aorta's deformation. Experimental results were confronted with medical data from AngioCT and 2D speckle-tracking echocardiography (2DSTE). RESULTS Image square analyses indicated that the optimal distance between the camera's lens and the investigated object was in the range of 0.30-0.35 m. There was approximately 1.44% difference observed in aneurysm diameters between NIVBS (86.57 ± 5.86 mm) and AngioCT (87.82 ± 6.04 mm) (p = 0.7764). The accuracy of developed algorithm for the reconstruction of the AAA deformation was equal to 98.56%. Bland-Altman analysis showed that the difference between clinical data (2DSTE) and predicted wall deformation (NIVBS) for all patients was 0.00 mm (confidence interval equal to 0.12 mm) for aneurysm size, 0.01 mm (confidence interval equal to 0.13 mm) and 0.00 mm (confidence interval equal to 0.09 mm) for the anterior and posterior side, as well as 0.01 mm (confidence interval equal to 0.18 mm) and 0.01 mm (confidence interval equal to 0.11 mm) for the left and right side. The optimal range of camera's lens did not affect acquired values. CONCLUSIONS The NIVBS with proposed algorithm that reconstructs the pressure from surrounding organs is appropriate to analyze the AAAs in water environment. Moreover, NIVBS allowed detailed quantitative analysis of aneurysm sac wall deformation.
Collapse
Affiliation(s)
- Andrzej Polanczyk
- Faculty of Process and Environmental Engineering, Department of Heat and Mass Transfer, Lodz University of Technology, Łódź, Poland.
| | - Michal Podgorski
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Łódź, Poland
| | - Maciej Polanczyk
- Faculty of Process and Environmental Engineering, Department of Heat and Mass Transfer, Lodz University of Technology, Łódź, Poland
| | | | - Ludomir Stefanczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Łódź, Poland
| | - Michal Strzelecki
- Institute of Electronics, Lodz University of Technology, Łódź, Poland
| |
Collapse
|
17
|
Kurokawa R, Maeda E, Mori H, Amemiya S, Sato J, Ino K, Torigoe R, Abe O. Effect of bolus tracking region-of-interest position within the descending aorta on luminal enhancement of coronary arteries in coronary computed tomography angiography. Medicine (Baltimore) 2019; 98:e15538. [PMID: 31083207 PMCID: PMC6531088 DOI: 10.1097/md.0000000000015538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To compare coronary artery luminal enhancement in coronary computed tomography angiography (CCTA) between ventral and dorsal region-of-interest (ROI) bolus tracking in the descending aorta.The records of 165 consecutive patients who underwent CCTA with non-helical acquisition from July 2017 to March 2018 were retrospectively examined. We performed 320-row CCTA with bolus tracking [scan triggered at 260 HU in the descending aorta] and 133 patients were finally included. ROI was set in the ventral and dorsal halves of the descending aorta in 68 and 65 patients, respectively.Contrast arrival time was significantly shorter in the dorsal group (ventral: 21.8 ± 0.372 s; dorsal: 20.7 ± 0.369; P = .0295). The mean density of the proximal and distal RCA was significantly higher in the ventral group (proximal: ventral, 428.1 ± 6.95 HU; dorsal, 405.5 ± 7.72 HU, P = .0318; distal: ventral, 418.0 ± 9.29 HU; dorsal, 393.2 ± 9.46 HU, P = .0133).Dorsal bolus tracking ROI in the descending thoracic aorta significantly reduced preparation time and RCA CT values.
Collapse
Affiliation(s)
- Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, University of Tokyo
| | - Eriko Maeda
- Department of Radiology, Graduate School of Medicine, University of Tokyo
| | - Harushi Mori
- Department of Radiology, Graduate School of Medicine, University of Tokyo
| | - Shiori Amemiya
- Department of Radiology, Graduate School of Medicine, University of Tokyo
| | - Jiro Sato
- Department of Radiology, Graduate School of Medicine, University of Tokyo
| | - Kenji Ino
- Department of Radiation Technology, University of Tokyo Hospital
| | | | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo
| |
Collapse
|
18
|
Wei W, Evin M, Rapacchi S, Kober F, Bernard M, Jacquier A, Kahn CJF, Behr M. Investigating heartbeat-related in-plane motion and stress levels induced at the aortic root. Biomed Eng Online 2019; 18:19. [PMID: 30808342 PMCID: PMC6391796 DOI: 10.1186/s12938-019-0632-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/31/2019] [Indexed: 12/28/2022] Open
Abstract
Background The axial motion of aortic root (AR) due to ventricular traction was previously suggested to contribute to ascending aorta (AA) dissection by increasing its longitudinal stress, but AR in-plane motion effects on stresses have never been studied. The objective is to investigate the contribution of AR in-plane motion to AA stress levels. Methods The AR in-plane motion was assessed on magnetic resonance imagining data from 25 healthy volunteers as the movement of the AA section centroid. The measured movement was prescribed to the proximal AA end of an aortic finite element model to investigate its influences on aortic stresses. The finite element model was developed from a patient-specific geometry using LS-DYNA solver and validated against the aortic distensibility. Fluid–structure interaction (FSI) approach was also used to simulate blood hydrodynamic effects on aortic dilation and stresses. Results The AR in-plane motion was 5.5 ± 1.7 mm with the components of 3.1 ± 1.5 mm along the direction of proximal descending aorta (PDA) to AA centroid and 3.0 ± 1.3 mm perpendicularly under the PDA reference system. The AR axial motion elevated the longitudinal stress of proximal AA by 40% while the corresponding increase due to in-plane motion was always below 5%. The stresses at proximal AA resulted approximately 7% less in FSI simulation with blood flow. Conclusions The AR in-plane motion was comparable with the magnitude of axial motion. Neither axial nor in-plane motion could directly lead to AA dissection. It is necessary to consider the heterogeneous pressures related to blood hydrodynamics when studying aortic wall stress levels. Electronic supplementary material The online version of this article (10.1186/s12938-019-0632-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Wei Wei
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France.
| | - Morgane Evin
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France
| | | | - Frank Kober
- Aix-Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Monique Bernard
- Aix-Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Alexis Jacquier
- Aix-Marseille Université, CNRS, CRMBM, UMR 7339, Marseille, France
| | - Cyril J F Kahn
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France
| | - Michel Behr
- Laboratoire de Biomécanique Appliquée, Aix-Marseille Université, IFSTTAR, LBA, UMR T24, 51 Bd. P. Dramard, 13015, Marseille, France
| |
Collapse
|
19
|
Additional diagnostic value of new CT imaging techniques for the functional assessment of coronary artery disease: a meta-analysis. Eur Radiol 2019; 29:3044-3061. [DOI: 10.1007/s00330-018-5919-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/30/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
|
20
|
Cami E, Tagami T, Raff G, Fonte TA, Renard B, Gallagher MJ, Chinnaiyan K, Bilolikar A, Fan A, Hafeez A, Safian RD. Assessment of lesion-specific ischemia using fractional flow reserve (FFR) profiles derived from coronary computed tomography angiography (FFRCT) and invasive pressure measurements (FFRINV): Importance of the site of measurement and implications for patient referral for invasive coronary angiography and percutaneous coronary intervention. J Cardiovasc Comput Tomogr 2018; 12:480-492. [DOI: 10.1016/j.jcct.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 08/07/2018] [Accepted: 09/09/2018] [Indexed: 11/27/2022]
|
21
|
Feldmann K, Cami E, Safian RD. Planning percutaneous coronary interventions using computed tomography angiography and fractional flow reserve‐derived from computed tomography: A state‐of‐the‐art review. Catheter Cardiovasc Interv 2018; 93:298-304. [DOI: 10.1002/ccd.27817] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/22/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Kyle Feldmann
- From the Department of Cardiovascular MedicineBeaumont Health Royal Oak Michigan
| | - Elvis Cami
- From the Department of Cardiovascular MedicineBeaumont Health Royal Oak Michigan
| | - Robert D. Safian
- From the Department of Cardiovascular MedicineBeaumont Health Royal Oak Michigan
| |
Collapse
|
22
|
Liu J, Quan J, Li Y, Wu Y, Yang L. Blood homocysteine levels could predict major adverse cardiac events in patients with acute coronary syndrome: A STROBE-compliant observational study. Medicine (Baltimore) 2018; 97:e12626. [PMID: 30290636 PMCID: PMC6200518 DOI: 10.1097/md.0000000000012626] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Global Registry of Acute Coronary Events (GRACE) risk score independently predicts major adverse cardiac events (MACEs) in patients with acute coronary syndrome (ACS). This study aims to evaluate whether the level of plasma homocysteine in addition to the GRACE score enhances the predictive value for MACEs in patients with acute coronary syndrome.A total of 361 patients with ACS evaluated at our hospital were included in the study and tested for blood homocysteine levels. We recorded 40 (11.1%) instances of MACE during a median follow-up of 43.3 months (quartile 40.6-44.4 months), including 29 cases (8.0%) of all-cause death and 11 cases (3.1%) of nonfatal myocardial infarction.The GRACE score was significantly associated with homocysteine levels, and multivariate Cox regression analysis showed that both the GRACE risk score and homocysteine content were independent predictors of MACEs (HR 2.63; 95% confidence interval (CI) 1.54 to 4.49; P < .001 and 2.27; 1.06 to 4.86; P = .035, respectively). Moreover, meta-analysis showed that as the homocysteine level increased, the incidence of MACEs also increased (log-rank 8.41; P = .015). GRACE scores adjusted by homocysteine level increased the area under the curve (AUC) from 0.78 to 0.83 (P = 0.006).Blood homocysteine levels are significantly associated with the GRACE risk score, and using both parameters can further improve risk stratification in patients with acute coronary syndrome.
Collapse
Affiliation(s)
- Jianlin Liu
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
| | - Jianjun Quan
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
- Department of Interventional Cardiology, Hanzhong Central Hospital, Hanzhong
| | | | - Yue Wu
- Department of Cardiology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Lin Yang
- Department of Vascular Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an
| |
Collapse
|
23
|
Agasthi P, Kanmanthareddy A, Khalil C, Egbuche O, Yarlagadda V, Sachdeva R, Arsanjani R. Comparison of Computed Tomography derived Fractional Flow Reserve to invasive Fractional Flow Reserve in Diagnosis of Functional Coronary Stenosis: A Meta-Analysis. Sci Rep 2018; 8:11535. [PMID: 30069020 PMCID: PMC6070545 DOI: 10.1038/s41598-018-29910-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/19/2018] [Indexed: 12/14/2022] Open
Abstract
Computed Tomography derived Fractional Flow Reserve (CTFFR) is an emerging non-invasive imaging modality to assess functional significance of coronary stenosis. We performed a meta-analysis to compare the diagnostic performance of CTFFR to invasive Fractional Flow reserve (FFR). Electronic search was performed to identify relevant articles. Pooled Estimates of sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-) and diagnostic odds ratio (DOR) with corresponding 95% confidence intervals (CI) were calculated at the patient level as well as the individual vessel level using hierarchical logistic regression, summary receiver operating characteristic (SROC) curve and area under the curve were estimated. Our search yielded 559 articles and of these 17 studies was included in the analysis. A total of 2,191 vessels in 1294 patients were analyzed. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-patient level were 83% (79-87), 72% (68-76), 3.0 (2.6-3.5), 0.23 (0.18-0.29) and 13 (9-18) respectively. Pooled estimates of sensitivity, specificity, LR+, LR- and DOR with corresponding 95% CI at per-vessel level were 85% (83-88), 76% (74-79), 3.6 (3.3-4.0), 0.19 (0.16-0.22) and 19 (15-24). The area under the SROC curve was 0.89 for both per patient level and at the per vessel level. In our meta-analysis, CTFFR demonstrated good diagnostic performance in identifying functionally significant coronary artery stenosis compared to the FFR.
Collapse
Affiliation(s)
- Pradyumna Agasthi
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA.
| | - Arun Kanmanthareddy
- Division of Cardiovascular Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Charl Khalil
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Obiora Egbuche
- Division of Cardiology, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Vivek Yarlagadda
- Department of Internal Medicine, Atlanticare Regional Medical Center, Atlantic City, New Jersey, USA
| | - Rajesh Sachdeva
- Division of Cardiology, Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Reza Arsanjani
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, Arizona, USA
| |
Collapse
|
24
|
Zhang D, Xu P, Qiao H, Liu X, Luo L, Huang W, Zhang H, Shi C. Carotid DSA based CFD simulation in assessing the patient with asymptomatic carotid stenosis: a preliminary study. Biomed Eng Online 2018. [PMID: 29530025 PMCID: PMC5848462 DOI: 10.1186/s12938-018-0465-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background Cerebrovascular events are frequently associated with hemodynamic disturbance caused by internal carotid artery (ICA) stenosis. It is challenging to determine the ischemia-related carotid stenosis during the intervention only using digital subtracted angiography (DSA). Inspired by the performance of well-established FFRct technique in hemodynamic assessment of significant coronary stenosis, we introduced a pressure-based carotid arterial functional assessment (CAFA) index generated from computational fluid dynamic (CFD) simulation in DSA data, and investigated its feasibility in the assessment of hemodynamic disturbance preliminarily using pressure-wired measurement and arterial spin labeling (ASL) MRI as references. Methods The cerebral multi-delay multi-parametric ASL-MRI and carotid DSA including trans-stenotic pressure-wired measurement were implemented on a 65-year-old man with asymptomatic unilateral (left) ICA stenosis. A CFD simulation using simplified boundary condition was performed in DSA data to calculate the CAFA index. The cerebral blood flow (CBF) and arterial transit time (ATT) of ICA territories were acquired. Results CFD simulation showed good correlation (r = 0.839, P = 0.001) with slight systematic overestimation (mean difference − 0.007, standard deviation 0.017) compared with pressure-wired measurement. No significant difference was observed between them (P = 0.09). Though the narrowing degree of in the involved ICA was about 70%, the simulated and measured CAFA (0.942/0.937) revealed a functionally nonsignificant stenosis which was also verified by a compensatory final CBF (fronto-temporal/fronto-parietal region: 51.58/45.62 ml/100 g/min) and slightly prolonged ATT (1.23/1.4 s) in the involved territories, together with a normal left–right percentage difference (2.1–8.85%). Conclusions The DSA based CFD simulation showed good consistence with invasive approach and could be used as a cost-saving and efficient way to study the relationship between hemodynamic disorder caused by ICA stenosis and subsequent perfusion variations in brain. Further research should focus on the role of noninvasive pressure-based CAFA in screening asymptomatic ischemia-causing carotid stenosis.
Collapse
Affiliation(s)
- Dong Zhang
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Pengcheng Xu
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Hongyu Qiao
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Xin Liu
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Liangping Luo
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China
| | - Wenhua Huang
- Department of Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Science, Southern Medical University, Guangzhou, 510515, China
| | - Heye Zhang
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institutes of Advanced Technology, 1068 Xueyuan Ave, Xili University Town, Nanshan, Shenzhen, 518055, Guangdong Province, China.
| | - Changzheng Shi
- Department of Medical Imaging Center, The First Affiliated Hospital, Jinan University, No. 613, Huangpu Road West, Tianhe District, Guangzhou, 510630, Guangdong Province, China.
| |
Collapse
|
25
|
Boileau E, Pant S, Roobottom C, Sazonov I, Deng J, Xie X, Nithiarasu P. Estimating the accuracy of a reduced-order model for the calculation of fractional flow reserve (FFR). INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34. [PMID: 28600860 DOI: 10.1002/cnm.2908] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
Image-based noninvasive fractional flow reserve (FFR) is an emergent approach to determine the functional relevance of coronary stenoses. The present work aimed to determine the feasibility of using a method based on coronary computed tomography angiography (CCTA) and reduced-order models (0D-1D) for the evaluation of coronary stenoses. The reduced-order methodology (cFFRRO ) was kept as simple as possible and did not include pressure drop or stenosis models. The geometry definition was incorporated into the physical model used to solve coronary flow and pressure. cFFRRO was assessed on a virtual cohort of 30 coronary artery stenoses in 25 vessels and compared with a standard approach based on 3D computational fluid dynamics (cFFR3D ). In this proof-of-concept study, we sought to investigate the influence of geometry and boundary conditions on the agreement between both methods. Performance on a per-vessel level showed a good correlation between both methods (Pearson's product-moment R=0.885, P<0.01), when using cFFR3D as the reference standard. The 95% limits of agreement were -0.116 and 0.08, and the mean bias was -0.018 (SD =0.05). Our results suggest no appreciable difference between cFFRRO and cFFR3D with respect to lesion length and/or aspect ratio. At a fixed aspect ratio, however, stenosis severity and shape appeared to be the most critical factors accounting for differences in both methods. Despite the assumptions inherent to the 1D formulation, asymmetry did not seem to affect the agreement. The choice of boundary conditions is critical in obtaining a functionally significant drop in pressure. Our initial data suggest that this approach may be part of a broader risk assessment strategy aimed at increasing the diagnostic yield of cardiac catheterisation for in-hospital evaluation of haemodynamically significant stenoses.
Collapse
Affiliation(s)
- Etienne Boileau
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| | - Sanjay Pant
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| | - Carl Roobottom
- Derriford Hospital and Peninsula Medical School, Plymouth Hospitals NHS Trust, Derriford Rd, Crownhill, Plymouth, PL6 8DH,, UK
| | - Igor Sazonov
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| | - Jingjing Deng
- Department of Computer Science, Swansea University, Swansea, SA2 8PP, UK
| | - Xianghua Xie
- Department of Computer Science, Swansea University, Swansea, SA2 8PP, UK
| | - Perumal Nithiarasu
- Zienkiewicz Centre for Computational Engineering, Engineering Central, College of Engineering, Swansea University Bay Campus, Swansea, SA1 8EN, UK
| |
Collapse
|