Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve

Wang, Rui; Renker, Matthias; Schoepf, U. Joseph; Wichmann, Julian L.; Fuller, Stephen R.; Rier, Jeremy; Bayer, Richard R.; Steinberg, Daniel; Cecco, Carlo N. De; Baumann, Stefan

doi:10.1016/j.ejrad.2015.05.010

Cited by 60 publications

(36 citation statements)

References 24 publications

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“…CCO is an attenuation based anatomic parameter and allows for normalized measurements, obtained from scanning over multiple heart cycles. [16] In accordance to previous trials using invasive FFR as the reference standard, we similarly observed that CCO was an effective predictor for hemodynamically relevant stenosis and showed a significant correlation with invasive iFR® [1,14,16]. Additionally, we demonstrate in a multivariable regression analysis that combined CCO, RI, and cCTA derived morphological plaque markers, such as the degree of luminal diameter stenosis, may have incremental predictive value over cCTA alone for the detection of functionally significant coronary arterial stenosis (AUC 0.93).…”

Section: Discussionmentioning

confidence: 99%

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Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses

Baumann

Özdemir

Tesche

et al. 2020

European Journal of Radiology

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Section: Discussionmentioning

confidence: 99%

“…The Poiseuille-based coronary angiographic index (LL/MLD 4 ) was calculated as the quotient of the lesion length (LL) divided by the 4 th power of the minimal luminal diameter (MLD 4 ). A threshold of LL/ MLD 4 > 3.86 was defined to indicate a hemodynamically significant lesion [16].…”

Section: Analysis Of Computed Tomographic Morphological Plaque Characmentioning

confidence: 99%

Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses

Baumann

Özdemir

Tesche

et al. 2020

European Journal of Radiology

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“…These include the work of Renker et al and others. [24][25][26][27][28][29][30][31] Unsurprisingly, a critical component of cFFR img is the physiological model that should be able to replicate the coronary flow and pressure during maximal hyperaemia. For both the 3D and reduced-order approaches to noninvasive FFR, adenosine administration is not required during imaging, which is generally performed under resting conditions.…”

Section: Noninvasive Ffrmentioning

confidence: 99%

“…31 Additional measurements, such as brachial pressure, can be used to derive aortic pressure and incorporated into more complex heart and coronary models; see related studies [16][17][18]36 and variants. 24,[26][27][28][29][30] Other boundary condition strategies include the prescription of pressure at the inlet, coupled with Windkessel models at the outlets 11 or steady-state simulations with uniform pressure and/or flow derived from imaging data 21,22 or else measured from 3D QCA and TIMI (thrombolysis in myocardial infarction) frame count. 20 In the present work, we demonstrate the feasibility of using CCTA imaging data and coronary flow simulations entirely based on reduced-order models to predict physiological measures such as FFR.…”

Section: Noninvasive Ffrmentioning

confidence: 99%

Estimating the accuracy of a reduced‐order model for the calculation of fractional flow reserve (FFR)

Boileau

Pant

Roobottom

et al. 2017

Numer Methods Biomed Eng

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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 (cFFR RO ) 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 (cFFR 3D ). 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 cFFR 3D 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 cFFR RO and cFFR 3D 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. KEYWORDSboundary conditions, coronary stenosis severity, shape and asymmetry, non-invasive fractional flow reserve, reduced-order model

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“…Thus, FFRCT may be useful for identifying patients who may benefit from revascularization and for prediction and optimization of PCI outcomes. [32][33][34] …”

Section: Accuracy Of Ffrctmentioning

confidence: 99%

CT Determination of Fractional Flow Reserve in Coronary Lesions

Mester¹,

Chițu

Raț

et al. 2016

Journal of Interdisciplinary Medicine

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Invasively determined fractional flow reserve (FFR) represents the gold-standard method for the functional evaluation of coronary lesions. Coronary computed tomography angiography (CCTA) provides characterization of the coronary anatomy, with important morphological information on the atherosclerotic plaques, but does not offer a hemodynamic evaluation of coronary artery lesions. CT evaluation of FFR (FFRCT) is a new noninvasive diagnostic method, which provides anatomical and functional assessment of the whole coronary tree, based on computational techniques, with no more radiation or hyperemic agent administration compared with routine CCTA. Recent studies demonstrated the safety and accuracy of FFRCT and its therapeutic use and cost benefits in real-world clinical use.

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Diagnostic value of quantitative stenosis predictors with coronary CT angiography compared to invasive fractional flow reserve

Cited by 60 publications

References 24 publications

Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses

Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses

Estimating the accuracy of a reduced‐order model for the calculation of fractional flow reserve (FFR)

CT Determination of Fractional Flow Reserve in Coronary Lesions

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