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Updated: Jul 13, 2026
Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Validation of a Novel Coronary Angiography-Derived Quantitative Functional Assessment Compared with Wire-Based FFR
Changwu Xu1, Qiang Xue2, Jianwen Liang3
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Insights
Synchronous computation of coronary angiography-derived fractional flow reserve (CAG-FFR) and index of microcirculatory resistance (CAG-IMR) offers high accuracy for assessing myocardial ischemia in coronary artery disease patients. This novel method shows significant clinical potential for on-site evaluation.
Area of Science:
- Cardiology
- Medical Imaging
- Computational Fluid Dynamics
Background:
- Coronary artery disease (CAD) diagnosis often requires assessing myocardial ischemia.
- Current methods for evaluating ischemia can be invasive and time-consuming.
- Novel, on-site assessment tools are needed for timely patient management.
Purpose of the Study:
- To evaluate the diagnostic performance of synchronous coronary angiography-derived fractional flow reserve (CAG-FFR) and coronary angiography-derived index of microcirculatory resistance (CAG-IMR).
- To compare the accuracy of CAG-FFR and CAG-IMR against invasive wire-based fractional flow reserve (FFR) and index of microcirculatory resistance (IMR).
Main Methods:
- A prospective, multicenter, controlled study.
- Calculation of CAG-FFR and CAG-IMR using a reduced order computational fluid dynamics solver.
- Incorporation of Thrombolysis in Myocardial Infarction (TIMI) frame count and invasive pressure sensor data.
- Utilized wire-based FFR and IMR as reference standards.
Main Results:
- CAG-FFR demonstrated 95.4% diagnostic accuracy (AUC 0.977) in 325 patients.
- CAG-IMR showed 95.5% diagnostic accuracy (AUC 0.973) in 180 patients.
- Patient-specific aortic pressure improved CAG-FFR accuracy in the 'gray zone'.
Conclusions:
- Synchronous CAG-FFR and CAG-IMR computation is feasible and highly accurate.
- This novel angiography-based method offers excellent diagnostic performance compared to traditional wire-based techniques.
- CAG-FFR and CAG-IMR hold significant clinical potential for the on-site evaluation of CAD.
Abstract:
Background: Synchronous computation of coronary angiography-derived fractional flow reserve (CAG-FFR) and coronary angiography-derived index of microcirculatory resistance (CAG-IMR) is a novel coronary angiography-based method for on-site assessment of suspected myocardial ischemia in patients with coronary artery disease (CAD). Methods: This trial is a prospective, multicenter, controlled study designed to assess the diagnostic performance of CAG-FFR and CAG-IMR in patients with suspected myocardial ischemia using wire-based FFR and IMR as reference standards. The functional parameters were calculated using a reduced order computational fluid dynamics solver that incorporates thrombolysis in myocardial infarction (TIMI) frame count and aortic pressure recorded by a disposable invasive pressure sensor. Results: CAG-FFR was computed in 325 patients, demonstrating a patient-level diagnostic accuracy of 95.4%, sensitivity of 95.9%, and specificity of 95.1%. The area under the receiver operating characteristic curve (AUC) of CAG-FFR was 0.977. Patient-specific aortic pressure adoption significantly improved the accuracy of CAG-FFR in the "gray zone" compared to fixed-pressure models. In addition, CAG-IMR was successfully computed in 180 patients, showing a patient-level diagnostic accuracy of 95.5%, sensitivity of 96.4%, and specificity of 95.2%. The AUC of CAG-IMR in diagnosing abnormal coronary microcirculatory dysfunction was 0.973. Conclusions: Synchronous computation of CAG-FFR and CAG-IMR demonstrated higher feasibility and excellent diagnostic accuracy compared to wire-based FFR and IMR, highlighting its clinical potential for CAD evaluation.
