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Noninvasive CT-based hemodynamic assessment of coronary lesions derived from fast computational analysis: a comparison against fractional flow reserve

  • Computed Tomography
  • Published:
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Abstract

Objectives

Application of computational fluid dynamics (CFD) to three-dimensional CTCA datasets has been shown to provide accurate assessment of the hemodynamic significance of a coronary lesion. We aim to test the feasibility of calculating a novel CTCA-based virtual functional assessment index (vFAI) of coronary stenoses > 30% and ≤ 90% by using an automated in-house-developed software and to evaluate its efficacy as compared to the invasively measured fractional flow reserve (FFR).

Methods and results

In 63 patients with chest pain symptoms and intermediate (20–90%) pre-test likelihood of coronary artery disease undergoing CTCA and invasive coronary angiography with FFR measurement, vFAI calculations were performed after 3D reconstruction of the coronary vessels and flow simulations using the finite element method. A total of 74 vessels were analyzed. Mean CTCA processing time was 25(± 10) min. There was a strong correlation between vFAI and FFR, (R = 0.93, p < 0.001) and a very good agreement between the two parameters by the Bland–Altman method of analysis. The mean difference of measurements from the two methods was 0.03 (SD = 0.033), indicating a small systematic overestimation of the FFR by vFAI. Using a receiver-operating characteristic curve analysis, the optimal vFAI cutoff value for identifying an FFR threshold of ≤ 0.8 was ≤ 0.82 (95% CI 0.81 to 0.88).

Conclusions

vFAI can be effectively derived from the application of computational fluid dynamics to three-dimensional CTCA datasets. In patients with coronary stenosis severity > 30% and ≤ 90%, vFAI performs well against FFR and may efficiently distinguish between hemodynamically significant from non-significant lesions.

Key Points

  • Virtual functional assessment index (vFAI) can be effectively derived from 3D CTCA datasets.

  • In patients with coronary stenoses severity > 30% and ≤ 90%, vFAI performs well against FFR.

  • vFAI may efficiently distinguish between functionally significant from non-significant lesions.

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Abbreviations

CACS:

Coronary artery calcium score

CAD:

Coronary artery disease

CFD:

Computational fluid dynamics

CTCA:

Computed tomography coronary angiography

FFR:

Fractional flow reserve

ICA:

Invasive coronary angiography

vFAI:

Virtual functional assessment index

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Funding

This work was supported in part by European Union FP7-CP-FP506 2007 (grant no. 222915) (EVINCI study) and in part by European Union’s Horizon 2020 research and innovation program under grant agreement no. 689068 (SMARTool study).

Author information

Author notes

  1. Panagiotis K. Siogkas and Constantinos D. Anagnostopoulos contributed equally to this work.

Authors and Affiliations

  1. Unit of Medical Technology and Intelligent Information Systems, Dept. of Materials Science and Engineering, University of Ioannina, Ioannina, Greece

    Panagiotis K. Siogkas & Dimitrios I. Fotiadis

  2. Center for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation, Academy of Athens, 4 Soranou Ephessiou St., 115 27, Athens, Greece

    Constantinos D. Anagnostopoulos

  3. Cardio-Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy

    Riccardo Liga

  4. Department of Nuclear Medicine, University Hospital Zurich, Zürich, Switzerland

    Riccardo Liga

  5. Biomedical Research Institute – FORTH, GR 45110 Ioannina, Ioannina, Greece

    Themis P. Exarchos, Antonis I. Sakellarios, George Rigas & Dimitrios I. Fotiadis

  6. Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands

    Arthur J. H. A. Scholte

  7. Michaelideion Cardiac Center, Dept. of Cardiology in Medical School, University of Ioannina, 451 10, Ioannina, Greece

    M. I. Papafaklis, Lampros K. Michalis & Dimitrios I. Fotiadis

  8. CT & MRI Department Hygeia-Mitera Hospitals, Athens, Greece

    Dimitra Loggitsi

  9. Fondazione Toscana G. Monasterio and CNR Institute of Clinical Physiology, Pisa, Italy

    Gualtiero Pelosi, Oberdan Parodi & Danilo Neglia

  10. Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland

    Teemu Maaniitty & Juhani Knuuti

Authors
  1. Panagiotis K. Siogkas
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  2. Constantinos D. Anagnostopoulos
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  8. M. I. Papafaklis
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Corresponding author

Correspondence to Constantinos D. Anagnostopoulos.

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Guarantor

The scientific guarantor of this publication is Constantinos D. Anagnostopoulos.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

In the context of the EVINCI study (Neglia D et al Circ Cardiovasc Imaging. 2015 Mar;8(3). pii: e002179. doi: https://doi.org/10.1161/CIRCIMAGING.114.002179), ethical approval was provided by each participating center and all subjects gave written informed consent. For the present study investigating anonymized imaging data, informed consent was waived.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

Additional information

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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Siogkas, P.K., Anagnostopoulos, C.D., Liga, R. et al. Noninvasive CT-based hemodynamic assessment of coronary lesions derived from fast computational analysis: a comparison against fractional flow reserve. Eur Radiol 29, 2117–2126 (2019). https://doi.org/10.1007/s00330-018-5781-8

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  • DOI: https://doi.org/10.1007/s00330-018-5781-8

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