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Computerised Methodologies for Non-Invasive Angiography-Derived Fractional Flow Reserve Assessment: A Critical Review
Anantharaman Ramasamy1,2, Chongying Jin1, Vincenzo Tufaro1
1Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, London, UK.
Insights
Fractional flow reserve (FFR) is crucial for assessing coronary artery blockages. Angiography-derived FFR offers a less invasive alternative, overcoming clinical limitations of traditional FFR methods.
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Medical imaging analysis
Background:
- Fractional flow reserve (FFR) is the gold standard for evaluating intermediate coronary artery stenoses.
- FFR-guided revascularization improves patient outcomes and reduces stent use.
- Clinical adoption of FFR is limited by patient/technical factors and costs.
Purpose of the Study:
- To review and critically appraise angiography-derived FFR technologies.
- To highlight methodologies, differences, and limitations of these novel FFR tools.
Main Methods:
- Review of existing literature on angiography-derived FFR software.
- Analysis of methodologies including fluid dynamics (e.g., Navier-Stokes) and simplified mathematical approaches.
- Comparison of technologies against invasive FFR validation studies.
Main Results:
- Several angiography-derived FFR software packages are available, avoiding invasive pressure measurements and hyperemic agents.
- These technologies demonstrate good accuracy and correlation with invasive FFR.
- Methodologies vary, employing complex fluid dynamics or simplified formulas.
Conclusions:
- Angiography-derived FFR presents a promising, less invasive alternative to traditional FFR.
- Understanding the diverse methodologies is key to appreciating their respective strengths and limitations.
- Further evaluation of these technologies is warranted for broader clinical integration.
Abstract:
Fractional flow reserve is the gold standard for assessing the haemodynamic significance of intermediate coronary artery stenoses. Cumulative evidence has shown that FFR-guided revascularisation reduces stent implantations and improves patient outcomes. However, despite the wealth of evidence and guideline recommendations, its use in clinical practice remains minimal. Patient and technical limitations of FFR as well as the need for intracoronary instrumentation, use of adenosine, and increased costs have limited FFR's applicability in clinical practice. Over the last decade, several angiography-derived FFR software packages have been developed which do not require intracoronary pressure assessment with a guidewire or need for administration of hyperaemic agents. At present, there are 3 commercially available software packages and several other non-commercial technologies that have been described in the literature. These technologies have been validated against invasive FFR showing good accuracy and correlation. However, the methodology behind these solutions is different-some algorithms are based on solving the governing equations of fluid dynamics such as the Navier-Stokes equation while others have opted for a more simplified mathematical formula approach. The aim of this review is to critically appraise the methodology behind all the known angiography-derived FFR technologies highlighting the key differences and limitations.
