Noninvasive CT-based hemodynamic assessment of coronary lesions derived from fast computational analysis: a comparison against fractional flow reserve

• Published in: European radiology 2019-04, Vol.29 (4), p.2117-2126
• Main Authors: Siogkas, Panagiotis K., Anagnostopoulos, Constantinos D., Liga, Riccardo, Exarchos, Themis P., Sakellarios, Antonis I., Rigas, George, Scholte, Arthur J. H. A., Papafaklis, M. I., Loggitsi, Dimitra, Pelosi, Gualtiero, Parodi, Oberdan, Maaniitty, Teemu, Michalis, Lampros K., Knuuti, Juhani, Neglia, Danilo, Fotiadis, Dimitrios I.
• Format: Article
• Language: English
• Subjects: Aged; Angiography; Blood vessels; Cardiovascular disease; Computational fluid dynamics; Computed Tomography; Computer applications; Computer simulation; Coronary Angiography - methods; Coronary artery; Coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - physiopathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Datasets; Diagnostic Radiology; Feasibility studies; Female; Finite element method; Fluid dynamics; Fractional Flow Reserve, Myocardial - physiology; Heart diseases; Hemodynamics - physiology; Humans; Hydrodynamics; Imaging; Imaging, Three-Dimensional; Internal Medicine; Interventional Radiology; Lesions; Male; Mathematical analysis; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Pain; Patients; Radiology; ROC Curve; Stenosis; Stents; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-018-5781-8

Objectives Application of computational fluid dynamics (CFD) to three-dimensional CTCA datasets has been shown to provide accurate assessment of the hemodynamic significance of a coronary lesion. We aim to test the feasibility of calculating a novel CTCA-based virtual functional assessment index (vFAI) of coronary stenoses > 30% and ≤ 90% by using an automated in-house-developed software and to evaluate its efficacy as compared to the invasively measured fractional flow reserve (FFR). Methods and results In 63 patients with chest pain symptoms and intermediate (20–90%) pre-test likelihood of coronary artery disease undergoing CTCA and invasive coronary angiography with FFR measurement, vFAI calculations were performed after 3D reconstruction of the coronary vessels and flow simulations using the finite element method. A total of 74 vessels were analyzed. Mean CTCA processing time was 25(± 10) min. There was a strong correlation between vFAI and FFR, ( R  = 0.93, p   30% and ≤ 90%, vFAI performs well against FFR and may efficiently distinguish between hemodynamically significant from non-significant lesions. Key Points Virtual functional assessment index (vFAI) can be effectively derived from 3D CTCA datasets. In patients with coronary stenoses severity > 30% and ≤ 90%, vFAI performs well against FFR. vFAI may efficiently distinguish between functionally significant from non-significant lesions.