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Functional Coronary Artery Assessment: a Systematic Literature Review

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Abstract

Cardiovascular diseases represent the number one cause of death in the world, including the most common disorders in the heart’s health, namely coronary artery disease (CAD). CAD is mainly caused by fat accumulated in the arteries’ internal walls, creating an atherosclerotic plaque that impacts the blood flow functional behavior. Anatomical plaque characteristics are essential but not sufficient for a complete functional assessment of CAD. In fact, plaque analysis and visual inspection alone have proven insufficient to determine the lesion severity and hemodynamic repercussion. Furthermore, the fractional flow reserve (FFR) exam, which is considered the gold standard for stenosis functional impair determination, is invasive and contains several limitations. Such a panorama evidences the need for new techniques applied to image exams to improve CAD functional assessment. In this article, we perform a systematic literature review on emerging methods determining CAD significance, thus delivering a unique base for comparing these methods, qualitatively and quantitatively. Our goal is to guide further studies with evidence from the most promising methods, highlighting the benefits from both areas. We summarize benchmarks, metrics for evaluation, and challenges already faced, thus shedding light on the requirements for a valid, meaningful, and accepted technique for functional assessment evaluation. We create a base of comparison based on quantitative and qualitative indicators and highlight the most relevant geometrical metrics that correlate with lesion significance. Finally, we point out future benchmarks based on recent literature.

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Funding

This work was partially supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES (Finance Code 001) and Conselho Nacional de Desenvolvimento Científico e Tecnológico – CNPq (grant 309537/2020-7).

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  1. Software Innovation Laboratory, Graduate Program in Applied Computing, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil

    Samuel A. Freitas, Cristiano A. da Costa &  Gabriel de O. Ramos

  2. Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

    Débora Nienow

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Samuel A. Freitas: Conceptualization, Methodology, Investigation, Formal analysis, Visualization, Writing – Original Draft. Débora Nienow: Resources, Writing – Reviewing and Editing. Cristiano A. da Costa: Methodology, Writing – Reviewing and Editing, Supervision. Gabriel de O. Ramos: Conceptualization, Methodology, Writing – Reviewing and Editing, Supervision.

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Correspondence to Gabriel de O. Ramos.

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Freitas, S.A., Nienow, D., da Costa, C.A. et al. Functional Coronary Artery Assessment: a Systematic Literature Review. Wien Klin Wochenschr 134, 302–318 (2022). https://doi.org/10.1007/s00508-021-01970-4

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