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Novel Non-invasive Fractional Flow Reserve from Coronary CT Angiography to Determine Ischemic Coronary Stenosis
Lavanya Cherukuri1, Divya Birudaraju1, Matthew J Budoff1,2
1The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center Torrance, CA.
Insights
Non-invasive fractional flow reserve (FFR) derived from coronary CT angiography (FFRCT) accurately diagnoses obstructive coronary artery disease (CAD). This cost-effective method aids understanding of plaque development and vulnerability in CAD patients.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Computational Fluid Dynamics
Background:
- Coronary artery disease (CAD) diagnosis often relies on invasive methods, with invasive fractional flow reserve (FFR) underutilized due to cost and time.
- Obstructive coronary artery disease is common, yet flow-limiting disease is infrequently diagnosed.
- Non-invasive imaging offers a potential solution to overcome FFR limitations.
Purpose of the Study:
- To evaluate the diagnostic accuracy and utility of non-invasively derived FFR from coronary CT angiography (FFRCT).
- To explore the relationship between hemodynamic forces, coronary plaque development, and plaque vulnerability.
- To establish FFRCT as an effective tool for assessing hemodynamically significant CAD.
Main Methods:
- Derivation of FFRCT using coronary CT angiography (CCTA) data.
- Comparison of FFRCT results with invasive FFR measurements.
- Analysis of FFRCT performance in challenging imaging scenarios (e.g., calcification, artifacts).
Main Results:
- FFRCT demonstrates excellent correlation with invasive FFR.
- FFRCT remains a reliable diagnostic tool despite image quality challenges like reduced signal-to-noise ratio, coronary calcification, and motion artifacts.
- The application of FFRCT enhances understanding of hemodynamically significant CAD.
Conclusions:
- Non-invasive FFRCT is a valuable and accurate diagnostic tool for coronary artery disease.
- FFRCT overcomes limitations of invasive FFR, offering a cost- and time-effective alternative.
- Further research into FFRCT can elucidate the interplay of hemodynamic forces in CAD progression and plaque vulnerability.
Abstract:
Coronary artery disease (CAD) patients may have an obstructive disease on invasive coronary angiography, but few of these patients have had flow-limiting obstructive disease diagnosed on invasive fractional flow reserve (FFR). FFR is infrequently performed because of its cost- and time-effectiveness. Advancement in non-invasive imaging has enabled FFR to be derived non-invasively using coronary CT angiography (CCTA), without the need for induction of hyperemia or modification of the standard CCTA acquisition protocol. FFR derived from CCTA (FFRCT) has been shown to have excellent correlation with invasive FFR, and remains an effective diagnostic tool in the presence of reduced signal-to-noise ratio, coronary calcification and motion artifact. The utility of FFRCT has also helped to deepen our understanding of hemodynamically significant CAD. Hence, there is now interest in exploring the possible interplay between these mechanistic forces and their effect on the development of coronary plaque and the vulnerability of these plaques.
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