Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology
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Citações na Scopus
26
Tipo de produção
article
Data de publicação
2019
Título da Revista
ISSN da Revista
Título do Volume
Editora
WILEY
Autores
HIDEO-KAJITA, Alexandre
BULANT, Carlos A.
MASO-TALOU, Gonzalo D.
FRANKEN, Marcelo
FEIJOO, Raul A.
Citação
CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, v.93, n.2, p.266-274, 2019
Resumo
Objectives: To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUSFR), compared to gold-standard invasive measurements (FFRINVAS). Background: IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel. Methods: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFRINVAS measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUSFR was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFRINVAS measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions. Results: A total of 24 patients with 34 vessels were analyzed. IVUSFR significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFRINVAS, with a mean difference of -0.008 +/- 0.067 (P = 0.47). IVUSFR presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis. Conclusion: The computational processing of IVUSFR is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS.
Palavras-chave
computational fluid dynamics, coronary blood flow/physiology/microvascular function, coronary artery disease, fractional flow reserve, imaging intravascular ultrasound, interventional devices/innovation, quantitative coronary angiography, three-dimensional coronary models
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