Fractional Flow Reserve Derived from Coronary Imaging and Computational Fluid Dynamics

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Computational Fluid Dynamics

Background:

• Invasive fractional flow reserve (FFR) is the gold standard for assessing the functional significance of coronary artery stenoses but involves risks and costs.
• Current non-invasive methods like coronary computed tomographic angiography (CCTA) primarily assess anatomic stenosis severity, not functional impact.

Purpose of the Study:

• To evaluate the feasibility and accuracy of non-invasively estimating FFR using CCTA and rotational angiography (RA) combined with computational fluid dynamics (CFD).
• To determine if these image-based FFR estimations can reliably identify functionally significant coronary artery disease.

Main Methods:

• FFR was estimated from CCTA and RA data using computational fluid dynamics (CFD) and image-based modeling.
• These non-invasive FFR estimations were compared to invasively measured FFR values and CCTA-derived anatomic stenosis severity.

Main Results:

• FFR derived from CCTA demonstrated superiority over CCTA stenosis severity in identifying lesion-specific ischemia.
• Estimated FFR from RA images and CFD showed agreement with invasively measured FFR values.
• These combined anatomic-functional assessments offer a less invasive diagnostic approach.

Conclusions:

• Non-invasive FFR estimation using CCTA or RA with CFD provides a viable, less invasive alternative to conventional invasive FFR.
• This approach has the potential to simplify the diagnosis of coronary artery disease and guide revascularization decisions.
• Identifying patients with ischemia-causing stenosis can be streamlined with a single diagnostic study.