Validation of novel 3‐dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Masdjedi, Kaneshka; Balbi, Matthew Mercieca; Nuis, Rutger‐Jan; Wilschut, Jeroen; Diletti, Roberto; Jaegere, Peter P.T. de; Zijlstra, Felix; Mieghem, Nicolas Van; Daemen, Joost

doi:10.1002/ccd.29311

Cited by 14 publications

(15 citation statements)

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“…The feasibility and excellent diagnostic performance of angiography-based FFR may increase the adoption rate of coronary physiological assessment in real-world practice. In this context, angiography-based FFR may play a role in specific clinical settings, such as non-culprit lesion assessment in ST elevation myocardial infarction ( 14 , 17 ), post coronary stenting ( 18 , 19 ), risk stratification ( 20 ) or event adjudication in clinical trials ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Chang

Lee

Chuang

et al. 2021

Front. Cardiovasc. Med.

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Background: Angiography-based functional assessment of coronary stenoses emerges as a novel approach to assess coronary physiology. We sought to investigate the agreement between invasive coronary wire-based fractional flow reserve (FFR), resting full-cycle ratio (RFR), and angiography-based vessel FFR (vFFR) for the functional assessment of coronary stenoses in patients with coronary artery disease.Materials and Methods: Between Jan 01, 2018, and Dec 31, 2020, 298 patients with 385 intermediate lesions received invasive coronary wire-based functional assessment (FFR, RFR or both) at a single tertiary medical center. Coronary lesions involving ostium or left main artery were excluded. vFFR analysis was performed retrospectively based on aortic root pressure and two angiographic projections.Results: In total, 236 patients with 291 lesions were eligible for vFFR analysis. FFR and RFR were performed in 258 and 162 lesions, respectively. The mean FFR, RFR and vFFR value were 0.84 ± 0.08, 0.90 ± 0.09, and 0.83 ± 0.10. vFFR was significantly correlated with FFR (r = 0.708, P < 0.001) and RFR (r = 0.673, P < 0.001). The diagnostic performance of vFFR vs. FFR was accuracy 81.8%, sensitivity 77.4%, specificity 83.9%, positive predictive value 69.9%, and negative predictive value 88.5%. The discriminative power of vFFR for FFR ≤ 0.80 or RFR ≤ 0.89 was excellent. Area under the receiver operating characteristic curve (AUC) was 0.87 (95% CI:0.83–0.92) for FFR and 0.80 (95% CI:0.73–0.88) for RFR.Conclusion: Angiography-based vFFR has a substantial agreement with invasive wire-based FFR and RFR in patients with intermediate coronary stenoses. vFFR can be utilized to assess coronary physiology without a pressure wire in a post hoc manner.

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Section: Discussionmentioning

confidence: 99%

Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Chang

Lee

Chuang

et al. 2021

Front. Cardiovasc. Med.

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“…The present study demonstrated that caFFR measurement had a good correlation with wire-based FFR measurement both before and after PCI. Similarly, post-PCI QFR and vFFR measurements correlated reasonably well-with post-PCI wire-based FFR measurements (28,29). However, in a retrospective study of data collected by more than 50 centers, a weak correlation was reported between vFFR measurement and wire-based FFR measurement because of poor image quality and the difficulty tracking aortic pressure (30).…”

Section: Discussionmentioning

confidence: 72%

Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention

Zheng

et al. 2021

Front. Cardiovasc. Med.

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Background: Coronary angiography-derived fractional flow reserve (caFFR) measurements have shown good correlations and agreement with invasive wire-based fractional flow reserve (FFR) measurements. However, few studies have examined the diagnostic performance of caFFR measurements before and after percutaneous coronary intervention (PCI). This study sought to compare the diagnostic performance of caFFR measurements against wire-based FFR measurements in patients before and after PCI.Methods: Patients who underwent FFR-guided PCI were eligible for the acquisition of caFFR measurements. Offline caFFR measurements were performed by blinded hospital operators in a core laboratory. The primary endpoint was the vessel-oriented composite endpoint (VOCE), defined as a composite of vessel-related cardiovascular death, vessel-related myocardial infarction, and target vessel revascularization.Results: A total of 105 pre-PCI caFFR measurements and 65 post-PCI caFFR measurements were compared against available wire-based FFR measurements. A strong linear correlation was found between wire-based FFR and caFFR measurements (r = 0.77; p < 0.001) before PCI, and caFFR measurements also showed a high correlation (r = 0.82; p < 0.001) with wire-based FFR measurements after PCI. A total of 6 VOCEs were observed in 61 patients during follow-up. Post-PCI FFR values (≤0.82) in the target vessel was the strongest predictor of VOCE [hazard ratio (HR): 5.59; 95% confidence interval (CI): 1.12–27.96; p = 0.036). Similarly, patients with low post-PCI caFFR values (≤0.83) showed an 8-fold higher risk of VOCE than those with high post-PCI caFFR values (>0.83; HR: 8.83; 95% CI: 1.46–53.44; p = 0.017).Conclusion: The study showed that the caFFR measurements were well-correlated and in agreement with invasive wire-based FFR measurements before and after PCI. Similar to wire-based FFR measurements, post-PCI caFFR measurements can be used to identify patients with a higher risk for adverse events associated with PCI.

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“…7 The FAST POST study demonstrated that the 3D-QCA derived post PCI vFFR correlates well with invasively measured microcatheter based FFR and has a high diagnostic accuracy to detect FFR <0.90 with low interobserver variability. 8 Another study demonstrated in patients with good quality angiographic visualization of left main coronary artery (LMCA), and available complete LMCA intravascular ultrasound (IVUS) footage, 3D-QCA based vFFR assessment of LMCA disease correlates well to LMCA minimum luminal area as assessed by IVUS. 9 The multicenter FAST (Fast Assessment of STenosis severity; NCT03791320) study, a prospective observational multicenter study designed to evaluate the diagnostic accuracy of offline 3D-QCA based FFR, using CAAS Workstation (Pie Medical Imaging, Maastricht, the Netherlands) in identifying hemodynamically significant CAD, compared with pressure-wire based FFR (≤0.80), is currently ongoing.…”

Section: Discussionmentioning

confidence: 99%

A novel vessel fraction flow reserve three-dimensional quantitative coronary angiography-based software. First case in Latin America

Ribeiro¹,

Boukhris²,

Dallan³

et al. 2021

J Transcat Intervent

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Fractional flow reserve has become the mainstay of functional hemodynamic assessment and is considered the gold standard to identify ischemic coronary stenoses. However, adopting the method into daily practice has been limited. Indeed, it requires the use of a costly pressure wire and the administration of a hyperemic agent. Vessel fractional flow reserve is a 3D-QCA based fractional flow reserve, using CAAS Workstation (version 8.4; Pie Medical Imaging, Maastricht, the Netherlands). It is a non-invasive method that does not require pressure wire or hyperemic agent; therefore it is time saving and easy to use. This is the first case performed in Brazil and demonstrates the correlation between fractional flow reserve and vessel fractional flow reserve performed in the same lesion, and the feasibility of calculation of vessel fractional flow reserve using 3D QCA-based software. We report the case of a 61-year-old male, who was admitted for typical chest pain. Coronary angiography revealed serial intermediate lesions in the mid- and distal left anterior descending. We evaluated left anterior descending lesions initially by fractional flow reserve then by vessel fractional flow reserve. Fractional flow reserve in distal left anterior descending was 0.65. Then, vessel fractional flow reserve value was calculated at 0.61. In our case, the correlation was adequate and the feasibility with offline calculation was excellent and fast. To the best of our knowledge, this is the first case of vessel fractional flow reserve performed in Latin America. Therefore, we expect vessel fractional flow reserve to be a game changer in management of coronary artery disease patients, particularly those with intermediate lesions.

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Validation of novel 3‐dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Cited by 14 publications

References 50 publications

Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Agreement Between Invasive Wire-Based and Angiography-Based Vessel Fractional Flow Reserve Assessment on Intermediate Coronary Stenoses

Agreement of Angiography-Derived and Wire-Based Fractional Flow Reserves in Percutaneous Coronary Intervention

A novel vessel fraction flow reserve three-dimensional quantitative coronary angiography-based software. First case in Latin America

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