Left and right coronary artery blood flow distribution method based on dominant type

Area of Science:

• Cardiology
• Medical Imaging
• Computational Fluid Dynamics

Background:

• Fractional flow reserve (FFR) is crucial for diagnosing coronary artery disease (CAD).
• Coronary computed tomography angiography (FFRct) offers a non-invasive method for FFR calculation.
• Accurate assessment of coronary artery flow distribution is vital for reliable FFRct results.

Purpose of the Study:

• To investigate the impact of left/right coronary artery flow distribution on FFRct calculations.
• To compare the diagnostic performance of the dominant type method versus a fixed ratio method for FFRct.

Main Methods:

• Collected data from 195 patients to categorize coronary artery dominance (right, balanced, left).
• Utilized a 0D/3D geometric multiscale model for numerical simulation of FFR in 73 CAD patients.
• Compared FFRct calculated by the dominant type method (D-FFRct) and fixed ratio method (F-FFRct) against invasive FFR (clinic-FFR).

Main Results:

• D-FFRct demonstrated a better correlation with invasive FFR (r=0.85) compared to F-FFRct (r=0.81).
• D-FFRct showed superior diagnostic performance with higher accuracy (94.52% vs. 90.41%) and AUC (0.974 vs. 0.960).
• The dominant type method, with specific flow distributions for each dominance type, proved more effective in detecting ischemic lesions.

Conclusions:

• Left/right coronary artery flow distribution significantly affects FFRct calculations.
• The dominant type method for FFRct is superior to the fixed ratio method for diagnosing coronary ischemic lesions.
• This study highlights the importance of incorporating patient-specific coronary anatomy into FFRct analysis.