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Published on: August 25, 2023
Noninvasive CT-Derived FFR Based on Structural and Fluid Analysis: A Comparison With Invasive FFR for Detection of
Brian S Ko1, James D Cameron1, Ravi K Munnur1
1Monash Cardiovascular Research Centre, MonashHEART, Department of Medicine, Monash Medical Centre, Monash Health, and Monash University, Melbourne, Victoria, Australia.
A new computed tomography (CT) fractional flow reserve (FFR) method using alternative boundary conditions is feasible and accurate for detecting significant coronary artery stenosis. This novel CT-FFR technique shows high reproducibility and requires minimal processing time for clinical use.
Area of Science:
- Cardiovascular imaging and intervention
- Computational fluid dynamics in medicine
- Diagnostic accuracy of non-invasive cardiac imaging
Background:
- Current fractional flow reserve (FFR) computation from coronary computed tomography angiography (CTA) relies on assumptions about microvascular resistance.
- Alternative methods for deriving boundary conditions, such as structural deformation, require further validation for accuracy.
Purpose of the Study:
- To assess the feasibility and accuracy of a novel computed tomography (CT) fractional flow reserve (FFR) technique.
- To evaluate a new method for determining boundary conditions based on coronary lumen and aortic deformation.
Main Methods:
- A novel CT-FFR technique was developed using boundary conditions derived from coronary lumen and aortic deformation.
- Hierarchical Bayes modeling and a reduced-order fluid model were employed for CT-FFR computation.
- The technique was validated in a cohort of 30 patients (58 vessels) after derivation in 12 patients (20 vessels).
Main Results:
- The CT-FFR technique demonstrated high accuracy in detecting functional stenosis (FFR ≤ 0.8), with an area under the curve of 0.88 in the validation cohort.
- Compared to coronary CTA alone, CT-FFR showed improved specificity (87% vs. 74%) and positive predictive value (74% vs. 60%).
- The method exhibited excellent reproducibility with low intraobserver and interobserver variability and a mean analysis time of approximately 27 minutes.
Conclusions:
- The novel CT-FFR method based on alternative boundary conditions is feasible, reproducible, and accurate for identifying significant coronary artery stenosis.
- This technique offers a rapid, point-of-care solution for functional assessment of coronary arteries.
- Further validation in large, multicenter prospective studies is warranted.
