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A novel method for calculating CTFFR based on the flow ratio between stenotic coronary and healthy coronary
Long Yu1, Weifeng Guo2, Wei He3
1Department of aeronautics and astronautics, Fudan University, Shanghai, China.
Insights
A new flow-based method, coronary CTQFFR, accurately assesses coronary artery stenosis without location dependency. This approach improves reliability for identifying significant coronary artery disease, a leading cause of death.
Area of Science:
- Cardiovascular imaging
- Computational fluid dynamics
- Medical diagnostics
Background:
- Obstructive coronary artery disease causes myocardial ischemia and is a leading cause of death.
- CT-derived fractional flow reserve (CT-FFR) noninvasively assesses coronary stenosis but is location-dependent.
- Existing CT-FFR methods are limited by measurement position variability.
Purpose of the Study:
- To develop a novel, location-independent flow-based approach for coronary CT-FFR (CTQFFR).
- To overcome the limitations of traditional CT-FFR measurements.
- To enhance the accuracy of noninvasive coronary artery stenosis assessment.
Main Methods:
- Established healthy-assumed coronary arteries based on narrowed arteries.
- Used numerical simulation to determine blood flow in stenotic and healthy-assumed arteries.
- Calculated CTQFFR as the ratio of blood flow, assuming unchanged microvascular resistance.
- Fitted the relationship between CTQFFR and FFR using data from 20 cases.
Main Results:
- CTQFFR showed a strong correlation with FFR (R²=0.8744) and CTPFFR (R²=0.9971).
- Preliminary validation in 10 cases demonstrated 100% accuracy in identifying clinically significant coronary stenosis.
- The method exhibited a low relative error (0.316%) compared to previous studies.
Conclusions:
- Coronary CTQFFR, a flow ratio method, offers a location-independent assessment of coronary stenosis.
- This novel approach improves the reliability of CT-FFR, especially near critical values.
- Preliminary results indicate high accuracy for detecting significant coronary artery stenosis, warranting further multi-center validation.
Background:
Epicardial coronary stenosis may lead to myocardial ischaemia, and the resulting obstructive coronary artery disease is one of the leading causes of death. CT-derived fractional flow reserve (CT-FFR) has been clinically shown to be an effective method for the noninvasive assessment of coronary artery stenosis. However, this method has the problem that the measurement result is affected by the selected measurement position.
Objectives:
This study was to obtain a novel flow-based approach to coronary CTFFR (CTQFFR), which was not affected by the measurement location.
Methods:
This study established healthy-assumed coronary arteries based on narrowed coronary arteries. Based on the assumption that the microvascular resistance remains unchanged in the short term after coronary stenosis treatment, the blood flow in the stenotic coronary artery and the healthy-assumed coronary artery was obtained by numerical simulation, and the CTQFFR based on the blood flow ratio was calculated. The functional relationship between CTQFFR and FFR was fitted by the results of 20 cases.
Results:
In this study, the functional relationship between CTQFFR and FFR was fitted by a quadratic curve, and the variance was 0.8744; the functional relationship between CTQFFR and pressure-based approach to coronary CTFFR (CTPFFR) was fitted by a primary curve, and the variance was 0.9971. There was coronary artery growth in all 20 cases. Preliminary validation results using 10 cases showed 100% accuracy in determining whether coronary artery stenosis required for clinical intervention. The relative error of the coefficient with the results proposed in a previous study was 0.316%.
Conclusion:
This study proposes a new method for calculating coronary CTFFR, namely, coronary CTQFFR, which is the flow ratio between stenotic coronary and healthy-assumed coronary. This method solves the problem that the downstream CTFFR of coronary stenosis is related to the selected location, which effectively improves the CTFFR at the critical value (CTFFR= 0.8) near reliability. Preliminary research results show that the method obtained in this study has a high accuracy for determining whether there is significant coronary stenosis. However, large multi-centre validation for the feasibility of this method was necessary in our future work.
