Non-invasive procedural planning using computed tomography-derived fractional flow reserve

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Medical Device Technology

Background:

• Fractional flow reserve derived from computed tomography (FFR_CT) technology allows simulation of hyperemic pressure changes.
• Advances enable virtual stenosis removal to predict post-intervention outcomes.

Purpose of the Study:

• To evaluate the FFR_CT planner's performance in predicting physiological benefits of PCI.
• To compare FFR_CT planner predictions with invasive post-PCI FFR measurements.

Main Methods:

• Invasive FFR measurements were taken before and after PCI in 56 patients (63 vessels).
• FFR_CT was calculated from pre-PCI coronary CT angiography.
• FFR_CT and invasive models were aligned for virtual stenosis removal, correlating pre- and post-PCI FFR with FFR_CT planner values.

Main Results:

• Pre-PCI FFR_CT and invasive FFR showed good agreement (r = 0.53).
• Post-PCI FFR_CT planner and invasive FFR showed significant correlation (r = 0.41, p < .001).
• Changes in FFR (delta FFR) also correlated significantly between invasive measurements and FFR_CT planner (r = 0.57, p < .001).

Conclusions:

• The FFR_CT planner demonstrates significant, though modest, agreement with post-PCI invasive FFR.
• The tool shows potential for aiding PCI procedural planning.
• Further technological advancements are necessary for reliable clinical application.