Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology.

MedStar author(s):
Citation: Catheterization & Cardiovascular Interventions. 93(2):266-274, 2019 02 01.PMID: 30277641Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Algorithms | *Coronary Artery Disease/dg [Diagnostic Imaging] | *Coronary Vessels/dg [Diagnostic Imaging] | *Fractional Flow Reserve, Myocardial | *Imaging, Three-Dimensional | *Ultrasonography, Interventional/mt [Methods] | Aged | Cardiac Catheterization | Coronary Angiography | Coronary Artery Disease/pp [Physiopathology] | Coronary Vessels/pp [Physiopathology] | Female | Humans | Male | Middle Aged | Predictive Value of Tests | Reproducibility of ResultsYear: 2019Local holdings: Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006ISSN:
  • 1522-1946
Name of journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & InterventionsAbstract: 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.CONCLUSION: The computational processing of IVUS<sub>FR</sub> 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.Copyright (c) 2018 Wiley Periodicals, Inc.METHODS: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFR<sub>INVAS</sub> 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 IVUS<sub>FR</sub> was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFR<sub>INVAS</sub> measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions.OBJECTIVES: To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUS<sub>FR</sub>), compared to gold-standard invasive measurements (FFR<sub>INVAS</sub>).RESULTS: A total of 24 patients with 34 vessels were analyzed. IVUS<sub>FR</sub> significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFR<sub>INVAS</sub>, with a mean difference of -0.008 +/- 0.067 (P = 0.47). IVUS<sub>FR</sub> 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.All authors: Bezerra CG, Blanco PJ, Bulant CA, Esteves-Filho A, Falcao BAA, Feijoo RA, Franken M, Garcia-Garcia HM, Hideo-Kajita A, Kalil-Filho R, Lemos PA, Mariani J Jr, Maso-Talou GD, Pinton FAOriginally published: Catheterization & Cardiovascular Interventions. 2018 Sep 12Fiscal year: FY2019Digital Object Identifier: ORCID: Date added to catalog: 2018-10-10
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30277641 Available 30277641

Available online from MWHC library: 1996 - present, Available in print through MWHC library: 1996 - 2006

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.

CONCLUSION: The computational processing of IVUS<sub>FR</sub> 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.

Copyright (c) 2018 Wiley Periodicals, Inc.

METHODS: Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFR<sub>INVAS</sub> 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 IVUS<sub>FR</sub> was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFR<sub>INVAS</sub> measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions.

OBJECTIVES: To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUS<sub>FR</sub>), compared to gold-standard invasive measurements (FFR<sub>INVAS</sub>).

RESULTS: A total of 24 patients with 34 vessels were analyzed. IVUS<sub>FR</sub> significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFR<sub>INVAS</sub>, with a mean difference of -0.008 +/- 0.067 (P = 0.47). IVUS<sub>FR</sub> 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.

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