On-site evaluation of CT-based fractional flow reserve using simple boundary conditions for computational fluid dynamics

  • Yusuke Yoshikawa
  • Masahiko Nakamoto
  • Masanori Nakamura
  • Takeharu Hoshi
  • Erika Yamamoto
  • Shunsuke Imai
  • Yoshiaki Kawase
  • Munenori Okubo
  • Hiroki Shiomi
  • Takeshi Kondo
  • Hitoshi Matsuo
  • Takeshi Kimura
  • Naritatsu SaitoEmail author
Original Paper


Fractional flow reserve (FFR) is an established method for diagnosing physiological coronary artery stenosis. A method for computing FFR using coronary computed tomography (CT) images was recently developed. However, its calculation requires off-site supercomputer analysis. Here, we report the preliminary result of a method using simple estimation of boundary conditions. The lumen boundaries of the coronary arteries were semi-automatically delineated using full width at half maximum of CT number profiles. The computational fluid dynamics (CFD) of the blood flow was performed using the boundary conditions of a fixed pressure at the coronary ostium and flow rates at each outlet. The total inflow at the coronary ostium was estimated based on the uniform wall shear stress hypothesis and corrected using a hyperemic multiplier to gain a hyperemic flow rate. The flow distribution from a parent vessel to the downstream daughter vessels was determined according to Murray’s law. FFR estimated by CFD was calculated as FFRCFD = Pd/Pa. We collected patients who underwent coronary CT and coronary angiography followed by invasively measured FFR and compared FFRCFD with FFR. Sensitivity, specificity, and correlations were assessed. A total of 48 patients and 72 arteries were assessed. The correlation coefficient of FFRCFD with FFR was 0.56. The cut-off value was ≤ 0.80, sensitivity was 59.1%, and specificity was 94.0%. CFD-based FFR using simple boundary conditions for on-site clinical computation provided FFRCFD values that were moderately correlated with invasively measured FFR.


Fractional flow reserve Computed tomography Coronary physiology Computational fluid dynamics 


Compliance with ethical standards

Conflicts of interest

None of the authors have anything to declare regarding this article. This study was conducted as a part of the project focused on creation of medical arts by Japan Agency for Medical Research and Development (Grant Number JP17hk0102035).

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

The need for written informed consent was waived because of the study’s retrospective design.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Yusuke Yoshikawa
    • 1
  • Masahiko Nakamoto
    • 2
  • Masanori Nakamura
    • 3
  • Takeharu Hoshi
    • 2
  • Erika Yamamoto
    • 1
  • Shunsuke Imai
    • 4
  • Yoshiaki Kawase
    • 4
  • Munenori Okubo
    • 4
  • Hiroki Shiomi
    • 1
  • Takeshi Kondo
    • 4
  • Hitoshi Matsuo
    • 4
  • Takeshi Kimura
    • 1
  • Naritatsu Saito
    • 1
    Email author
  1. 1.Department of Cardiovascular MedicineKyoto University Graduate School of MedicineKyotoJapan
  2. 2.EBM CorporationTokyoJapan
  3. 3.Biomechanics LaboratoryElectrical and Mechanical Engineering, Nagoya Institute of TechnologyNagoyaJapan
  4. 4.Department of Cardiovascular MedicineGifu Heart CenterGifuJapan

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