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Diagnostic performance of angiography-derived fractional flow reserve analysis based on bifurcation fractal law for assessing hemodynamic significance of coronary stenosis

  • Imaging Informatics and Artificial Intelligence
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Blood flow into the side branch affects the calculation of coronary angiography-derived fractional flow reserve (FFR), called Angio-FFR. Neglecting or improperly compensating for the side branch flow may decrease the diagnostic accuracy of Angio-FFR. This study aims to evaluate the diagnostic accuracy of a novel Angio-FFR analysis that considers the side branch flow based on the bifurcation fractal law.

Methods

A one-dimensional reduced-order model based on the vessel segment was used to perform Angio-FFR analysis. The main epicardial coronary artery was divided into several segments according to the bifurcation nodes. Side branch flow was quantified using the bifurcation fractal law to correct the blood flow in each vessel segment. In order to verify the diagnostic performance of our Angio-FFR analysis, two other computational methods were taken as control groups: (i) FFR_s: FFR calculated by delineating the coronary artery tree to consider side branch flow, (ii) FFR_n: FFR calculated by just delineating the main epicardial coronary artery and neglecting the side branch flow.

Results

The analysis of 159 vessels from 119 patients showed that our Anio-FFR calculation method had comparable diagnostic accuracy to FFR_s and provided significantly higher diagnostic accuracy than that of FFR_n. In addition, using invasive FFR as a reference, the Pearson correlation coefficients of Angio-FFR and FFRs were 0.92 and 0.91, respectively, while that of FFR_n was only 0.85.

Conclusions

Our Angio-FFR analysis has demonstrated good diagnostic performance in assessing the hemodynamic significance of coronary stenosis by using the bifurcation fractal law to compensate for side branch flow.

Clinical relevance statement

Bifurcation fractal law can be used to compensate for side branch flow during the Angio-FFR calculation of the main epicardial vessel. Compensating for side branch flow can improve the ability of Angio-FFR to diagnose stenosis functional severity.

Key Points

• The bifurcation fractal law could accurately estimate the blood flow from the proximal main vessel into the main branch, thus compensating for the side branch flow.

• Angiography-derived FFR based on the bifurcation fractal law is feasible to evaluate the target diseased coronary artery without delineating the side branch.

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Abbreviations

Angio-FFR:

Coronary angiography-derived fractional flow reserve based on bifurcation fractal law

AUC:

Area under the receiver operating characteristic curve

CABG:

Coronary artery bypass grafting

DBP:

Diastolic blood pressure

FFR:

Fractional flow reserve

FFR_finet:

FFR calculated based on Finet’s law

FFR_murray:

FFR calculated based on Murray’s law

FFR_n:

FFR calculated by just delineating the main epicardial coronary artery

FFR_s :

FFR calculated by delineating the coronary artery tree

LAD :

Left anterior descending artery

LCX:

Left circumflex artery

MB:

Main branch

MI :

Myocardial infarction

NPV:

Negative predictive value

PCI:

Percutaneous coronary intervention

PM:

Proximal main vessel

PPV:

Positive predictive value

RCA:

Right coronary artery

SB:

Side branch

SBP:

Systolic blood pressure

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Funding

This study has received funding from the Clinical Research Program of Nanfang Hospital, Southern Medical University (2021CR007), and the National Natural Science Foundation of China (81974266, 82270439, 62101610).

Author information

Authors and Affiliations

  1. Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China

    Hongbin Liang, Qiuxia Zhang, Yiting Gao, Guojun Chen, Yujia Bai, Yanan Zhang, Kai Cui, Qiancheng Wang, Shiping Cao, Yuqing Hou & Jiancheng Xiu

  2. School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen, China

    Heye Zhang & Xiujian Liu

  3. University, 2020 Foundation, Northborough, MA, USA

    Dhijnoo N. Ghista

Authors
  1. Hongbin Liang
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  2. Qiuxia Zhang
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Corresponding authors

Correspondence to Xiujian Liu or Jiancheng Xiu.

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The scientific guarantor of this publication is Xiujian Liu.

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.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

• diagnostic or prognostic study

• performed at one institution

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Liang, H., Zhang, Q., Gao, Y. et al. Diagnostic performance of angiography-derived fractional flow reserve analysis based on bifurcation fractal law for assessing hemodynamic significance of coronary stenosis. Eur Radiol 33, 6771–6780 (2023). https://doi.org/10.1007/s00330-023-09682-1

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