Coronary CT angiography-derived fractional flow reserve correlated with invasive fractional flow reserve measurements -initial experience with a novel physician-driven algorithm

详细信息    查看全文

• 作者：Stefan Baumann ; Rui Wang ; U. Joseph Schoepf ; Daniel H. Steinberg…
• 关键词：Coronary artery disease ; Coronary CT angiography ; Fractional flow reserve ; Invasive coronary angiography ; Myocardial ischemia
• 刊名：European Radiology
• 出版年：2015
• 出版时间：April 2015
• 年：2015
• 卷：25
• 期：4
• 页码：1201-1207
• 全文大小：420 KB
• 参考文献：1. Pijls, NH, Bruyne, B, Peels, K (1996) Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334: pp. 1703-1708 CrossRef
  2. Toth, G, Bruyne, B, Casselman, F (2013) Fractional flow reserve-guided versus angiography-guided coronary artery bypass graft surgery. Circulation 128: pp. 1405-1411 CrossRef
  3. Tonino, PA, Bruyne, B, Pijls, NH (2009) Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 360: pp. 213-224 CrossRef
  4. Frauenfelder, T, Boutsianis, E, Schertler, T (2007) In-vivo flow simulation in coronary arteries based on computed tomography datasets: feasibility and initial results. Eur Radiol 17: pp. 1291-1300 CrossRef
  5. Grunau, GL, Min, JK, Leipsic, J (2013) Modeling of fractional flow reserve based on coronary CT angiography. Curr Cardiol Rep 15: pp. 336 CrossRef
  6. Min, JK, Leipsic, J, Pencina, MJ (2012) Diagnostic accuracy of fractional flow reserve from anatomic CT angiography. JAMA 308: pp. 1237-1245 CrossRef
  7. Koo, BK, Erglis, A, Doh, JH (2011) Diagnosis of ischemia-causing coronary stenoses by noninvasive fractional flow reserve computed from coronary computed tomographic angiograms. Results from the prospective multicenter DISCOVER-FLOW (diagnosis of ischemia-causing stenoses obtained Via noninvasive fractional flow reserve) study. J Am Coll Cardiol 58: pp. 1989-1997 CrossRef
  8. Norgaard, BL, Leipsic, J, Gaur, S (2014) Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (analysis of coronary blood flow using CT angiography: next steps). J Am Coll Cardiol 63: pp. 1145-1155 CrossRef
  9. Sianos, G, Morel, MA, Kappetein, AP (2005) The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroInterv 1: pp. 219-227
  10. Husmann, L, Alkadhi, H, Boehm, T (2006) Influence of cardiac hemodynamic parameters on coronary artery opacification with 64-slice computed tomography. Eur Radiol 16: pp. 1111-1116 CrossRef
  11. Itu L, Sharma P, Mihalef V, Kamen A, Suciu C, Lomaniciu D (2012) A patient-specific reduced-order model for coronary circulationBiomedical Imaging (ISBI), 2012 9th IEEE International Symposium on, pp 832-835
  12. Sharma, P, Itu, L, Zheng, X (2012) A framework for personalization of coronary flow computations during rest and hyperemia. Conf Proc IEEE Eng Med Biol Soc 2012: pp. 6665-6668
  13. Wilson, RF, Wyche, K, Christensen, BV, Zimmer, S, Laxson, DD (1990) Effects of adenosine on human coronary arterial circulation. Circulation 82: pp. 1595-1606 CrossRef
  14. Raff, GL, Abidov, A, Achenbach, S (2009) SCCT guidelines for the interpretation and reporting of coronary computed tomographic angiography. J Cardiovasc Comput Tomogr 3: pp. 122-136 CrossRef
  15. Cecco, CN, Meinel, FG, Chiaramida, SA, Costello, P, Bamberg, F, Schoepf, UJ (2014) Coronary artery computed tomography scanning. Circulation 129: pp. 1341-1345 CrossRef
  16. Ebersberger, U, Marcus, RP, Schoepf, UJ (2014) Dynamic CT myocardial perfusion imaging: performance of 3D semi-automated evaluation software. Eur Radiol 24: pp. 191-199 CrossRef
  17. Thilo, C, Schoepf, UJ, Gordon, L, Chiaramida, S, Serguson, J, Costello, P (2009) Integrated ass
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Diagnostic Radiology
  Interventional Radiology
  Neuroradiology
  Ultrasound
  Internal Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-1084

文摘

Objectives The present study aimed to determine the feasibility of a novel fractional flow reserve (FFR) algorithm based on coronary CT angiography (cCTA) that permits point-of-care assessment, without data transfer to core laboratories, for the evaluation of potentially ischemia-causing stenoses. Methods To obtain CT-based FFR, anatomical coronary information and ventricular mass extracted from cCTA datasets were integrated with haemodynamic parameters. CT-based FFR was assessed for 36 coronary artery stenoses in 28 patients in a blinded fashion and compared to catheter-based FFR. Haemodynamically relevant stenoses were defined by an invasive FFR ?.80. Time was measured for the processing of each cCTA dataset and CT-based FFR computation. Assessment of cCTA image quality was performed using a 5-point scale. Results Mean total time for CT-based FFR determination was 51.9?±-.0?min. Per-vessel analysis for the identification of lesion-specific myocardial ischemia demonstrated good correlation (Pearson’s product-moment r--.74, p--.0001) between the prototype CT-based FFR algorithm and invasive FFR. Subjective image quality analysis resulted in a median score of 4 (interquartile ranges, 3-4). Conclusions Our initial data suggest that the CT-based FFR method for the detection of haemodynamically significant stenoses evaluated in the selected population correlates well with invasive FFR and renders time-efficient point-of-care assessment possible. Key Points -CT-based FFR computation is a promising novel non-invasive application. -A novel prototype algorithm permits time-efficient point-of-care CT-based FFR assessment. -Initial results of the CT-based FFR prototype algorithm compare favourably with FFR.