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Pressure-flow curve derived from coronary CT angiography for detection of significant hemodynamic stenosis

  • Cardiac
  • Published:
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Abstract

Objectives

Coronary CT angiography (cCTA) has been used to non-invasively assess both the anatomical and hemodynamic significance of coronary stenosis. The current study investigated a new CFD-based method of evaluating pressure-flow curves across a stenosis to further enhance the diagnostic value of cCTA imaging.

Methods

Fifty-eight patients who underwent both cCTA imaging and invasive coronary angiography (ICA) with fractional flow reserve (FFR) within 2 weeks were enrolled. The pressure-flow curve–derived parameters, viscous friction (VF) and expansion loss (EL), were compared with conventional cCTA parameters including percent area stenosis (AS) and minimum lumen area (MLA) by receiver operating characteristic (ROC) curve analysis. FFR ≤ 0.80 was used to indicate ischemia-causing stenosis. Correlations between FFR and other measurements were calculated by Spearman’s rank correlation coefficient (rho).

Results

Sixty-eight stenoses from 58 patients were analyzed. VF, EL, and AS were significantly larger in the group of FFR ≤ 0.8 while smaller MLA values were observed. The ROC-AUC of VF (0.91, 95% CI 0.81–0.96) was better than that of AS (change in AUC (ΔAUC) 0.27, p < 0.05) and MLA (ΔAUC 0.17, p < 0.05), and ROC-AUC of EL (0.90, 95%CI 0.80–0.96) was also better than that of AS (ΔAUC 0.26, p < 0.05) and MLA (ΔAUC 0.16, p < 0.05). FFR values correlated well with VF (rho = − 0.74 (95% CI − 0.83 to − 0.61, p < 0.0001) and EL (rho = − 0.74 (95% CI − 0.83 to − 0.61, p < 0.0001).

Conclusion

Pressure-flow curve–derived parameters enhance the diagnostic value of cCTA examination.

Key Points

• Pressure-flow curve derived from cCTA can assess coronary lesion severity.

• VF and EL are superior to cCTA alone for indicating ischemic lesions.

• Pressure-flow curve derived from cCTA may assist in clinical decision-making.

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Abbreviations

AS:

Area stenosis

AUC:

Area under the receiver operator characteristic curve

CAD:

Coronary artery disease

cCTA:

Coronary computed tomographic angiography

CDP:

Pressure drop coefficient

CFD:

Computational fluid dynamic

EL:

Expansion loss

FFR:

Fractional flow reserve

FFR-CT:

Fractional flow reserve derived from coronary computed tomographic angiography

HU:

Hounsfield units

ICA:

Invasive coronary angiography

MLA:

Minimum lumen area

Rho:

Spearman’s rank correlation coefficient

ROC:

Receiver operating characteristic

ROI:

Region of interest

VF:

Viscous friction

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Funding

This study has received funding by the National Natural Science Foundation of China (Grant No. 61601368), the Fundamental Research Funds for the Central Universities (No. 3102018ZY021) and the Discipline promotion project of Xijing hospital (No. XJZT18MJ52).

Author information

Authors and Affiliations

  1. Department of Information Engineering, Northwestern Polytechnical University, Xi’an, Shaanxi, People’s Republic of China

    Xinzhou Xie, Ruichen Zhang & Songyun Xie

  2. Department of Radiology, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi, People’s Republic of China

    Didi Wen & Minwen Zheng

  3. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands

    Qian Tao

  4. Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, People’s Republic of China

    Ce Wang & Hui Liu

Authors
  1. Xinzhou Xie
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  2. Didi Wen
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  3. Ruichen Zhang
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  4. Qian Tao
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  5. Ce Wang
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  6. Songyun Xie
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  7. Hui Liu
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  8. Minwen Zheng
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Corresponding authors

Correspondence to Hui Liu or Minwen Zheng.

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Guarantor

The scientific guarantor of this publication is Minwen Zheng.

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

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Xie, X., Wen, D., Zhang, R. et al. Pressure-flow curve derived from coronary CT angiography for detection of significant hemodynamic stenosis. Eur Radiol 30, 4347–4355 (2020). https://doi.org/10.1007/s00330-020-06821-w

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  • DOI: https://doi.org/10.1007/s00330-020-06821-w

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