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Published on: April 13, 2015
Simplified coronary flow reserve calculations based on three-dimensional coronary reconstruction and intracoronary
Benjamin Csippa1, Áron Üveges2,3,4, Dániel Gyürki1
1Department of Hydrodynamic Systems, Budapest University of Technology and Economics, Budapest, Hungary.
Insights
A simple hemodynamic model accurately calculates coronary flow reserve (CFR) using 3D angiography and pressure data. This method aids in diagnosing microvascular dysfunction by assessing the CFR/FFR ratio.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Medical Imaging
Background:
- Fractional flow reserve (FFR) and coronary flow reserve (CFR) are key for hemodynamic assessment of coronary lesions.
- Combined epicardial and microvascular disease necessitates complex hemodynamic evaluation.
- This study validates a simplified CFR calculation against detailed computational fluid dynamics (CFD).
Purpose of the Study:
- To validate a simple hemodynamic model for calculating CFR.
- To compare CFR derived from a simple model with CFD analysis.
- To assess the feasibility of using 3D-angiography and pressure measurements for CFR calculation.
Main Methods:
- Utilized 3D morphological data and pressure values from FFR measurements.
- Included nine patients with single intermediate coronary stenosis, measured via pressure wire.
- Calculated CFR using a simple hemodynamic model and compared it with CFD analysis.
Main Results:
- Strong correlation found between simple equation-derived CFR and steady flow simulation (r = 0.984, p < 10-5).
- Significant correlation observed between transient and steady flow simulation CFR values (r = 0.94, p < 10-3).
Conclusions:
- Demonstrated feasibility of simple hemodynamic CFR calculation using 3D-angiography and intracoronary pressure.
- Simultaneous FFR and CFR determination enables diagnosis of microvascular dysfunction.
- The CFR/FFR ratio effectively characterizes microvascular reserve.
Background:
Measurements of fractional flow reserve (FFR) and/or coronary flow reserve (CFR) are widely used for hemodynamic characterization of coronary lesions. The frequent combination of the epicardial and microvascular disease may indicate a need for complex hemodynamic evaluation of coronary lesions. This study aims at validating the calculation of CFR based on a simple hemodynamic model to detailed computational fluid dynamics (CFD) analysis.
Methods:
Three-dimensional (3D) morphological data and pressure values from FFR measurements were used to calculate the target vessel. Nine patients with one intermediate stenosis each, measured by pressure wire, were included in this study.
Results:
A correlation was found between the determined CFR from simple equations and from a steady flow simulation (r = 0.984, p < 10-5). There was a significant correlation between the CFR values calculated by transient and steady flow simulations (r = 0.94, p < 10-3).
Conclusions:
Feasibility was demonstrated of a simple hemodynamic calculation of CFR based on 3D-angiography and intracoronary pressure measurements. A simultaneous determination of both the FFR and CFR values provides the capability to diagnose microvascular dysfunction: the CFR/FFR ratio characterizes the microvascular reserve.
