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European Radiology

, Volume 27, Issue 4, pp 1416–1423 | Cite as

The effect of blood pressure on non-invasive fractional flow reserve derived from coronary computed tomography angiography

  • Akira KurataEmail author
  • Adriaan Coenen
  • Marisa M. Lubbers
  • Koen Nieman
  • Teruhito Kido
  • Tomoyuki Kido
  • Natsumi Yamashita
  • Kouki Watanabe
  • Gabriel P. Krestin
  • Teruhito Mochizuki
Cardiac

Abstract

Objectives

The aim of this study is to assess the effect of blood pressure (BP) on coronary computed tomography angiography (CTA) derived computational fractional flow reserve (CTA-FFR).

Materials and methods

Twenty-one patients who underwent coronary CTA and invasive FFR were retrospectively identified. Ischemia was defined as invasive FFR ≤0.80. Using a work-in-progress computational fluid dynamics algorithm, CTA-FFR was computed with BP measured before CTA, and simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg respectively. Correlation between CTA-FFR and invasive FFR was assessed using Pearson test. The repeated measuring test was used for multiple comparisons of CTA-FFR values by simulated BP inputs.

Results

Twenty-nine vessels (14 with invasive FFR ≤0.80) were assessed. The average CTA-FFR for measured BP (134 ± 20/73 ± 12 mmHg) was 0.77 ± 0.12. Correlation between CTA-FFR by measured BP and invasive FFR was good (r = 0.735, P < 0.001). For simulated BPs of 60/50, 90/60, 110/70, 130/80, 150/90, and 180/100 mmHg, the CTA-FFR increased: 0.69 ± 0.13, 0.73 ± 0.12, 0.75 ± 0.12, 0.77 ± 0.11, 0.79 ± 0.11, and 0.81 ± 0.10 respectively (P < 0.05).

Conclusion

Measurement of the BP just before CTA is preferred for accurate CTA-FFR simulation. BP variations in the common range slightly affect CTA-FFR. However, inaccurate BP assumptions differing from the patient-specific BP could cause misinterpretation of borderline significant lesions.

Key Points

The blood pressure (BP) affects the CTA-FFR computation.

Measured BP before CT examination is preferable for accurate CTA-FFR simulation.

Inaccurate BP assumptions can cause misinterpretation of borderline significant lesions.

Keywords

Coronary artery disease Computed tomography Fractional flow reserve Blood pressure Myocardial ischemia 

Abbreviations and acronyms

BP

blood pressure

CAC

coronary artery calcium

CAD

coronary artery disease

CAG

coronary angiography

CTA

CT angiography

FFR

fractional flow reserve

DBP

diastolic blood pressure

MAP

mean arterial pressure

PCI

percutaneous coronary intervention

SBP

systolic blood pressure

3-D

3-dimensional

Notes

Acknowledgments

The scientific guarantor of this publication is Koen Nieman. 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. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper.

Institutional Review Board approval was obtained at each institution. Written informed consent was waived by the Institutional Review Board due to retrospective observational nature of the study. Methodology: The study was designed as prospective, observational, multi-centre study.

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Akira Kurata
    • 1
    • 2
    Email author
  • Adriaan Coenen
    • 2
    • 3
  • Marisa M. Lubbers
    • 2
    • 3
  • Koen Nieman
    • 2
    • 3
  • Teruhito Kido
    • 1
  • Tomoyuki Kido
    • 4
  • Natsumi Yamashita
    • 5
  • Kouki Watanabe
    • 6
  • Gabriel P. Krestin
    • 2
  • Teruhito Mochizuki
    • 1
  1. 1.Department of RadiologyEhime University Graduate School of MedicineToonJapan
  2. 2.Department of RadiologyErasmus University Medical CenterRotterdamthe Netherlands
  3. 3.Departmenet of CardiologyErasmus University Medical CenterRotterdamthe Netherlands
  4. 4.Department of RadiologyMatsuyama Saiseikai HospitalMatsuyamaJapan
  5. 5.Division of Clinical Biostatistics, Section of Cancer Prevention and EpidemiologyClinical Research Center, National Hospital Organization Shikoku Cancer CenterMatsuyamaJapan
  6. 6.Department of CardiologyMatsuyama Saiseikai HospitalMatsuyamaJapan

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