title: Advances in three-dimensional coronary imaging and computational fluid dynamics: is virtual fractional flow reserve more than just a pretty picture?
abstract: Percutaneous coronary intervention (PCI) has shown a high success rate in the treatment of coronary artery disease. The decision to perform PCI often relies on the cardiologist's visual interpretation of coronary lesions during angiography. This has inherent limitations, particularly due to the low resolution and two-dimensional nature of angiography. State-of-the-art modalities such as three-dimensional quantitative coronary angiography, optical coherence tomography and invasive fractional flow reserve (FFR) may improve clinicians' understanding of both the anatomical and physiological importance of coronary lesions. While invasive FFR is the gold standard technique for assessment of the haemodynamic significance of coronary lesions, recent studies have explored a surrogate for FFR derived solely from three-dimensional reconstruction of the invasive angiogram, and therefore eliminating need for a pressure wire. Utilizing advanced computational fluid dynamics research, this virtual fractional flow reserve (vFFR) has demonstrated reasonable correlation with invasive measurements and remains an intense area of ongoing study. However, at present, several limitations and computational fluid dynamic assumptions may preclude vFFR from widespread clinical use. This review demonstrates the tight integration of advanced three-dimensional imaging techniques and vFFR in assessing coronary artery disease, reviews the advantages and disadvantages of such techniques and attempts to provide a glimpse of how such advances may benefit future clinical decision-making during PCI.
authors.affiliation: aDepartment of Mechanical Engineering, Melbourne School of Engineering bNorth West Academic Centre, Melbourne Medical School cIBM Research Collaboratory for Life Sciences-Melbourne, Victoria Life Sciences Computation Initiative, The University of Melbourne, Melbourne, Victoria, Australia dNational Heart Research Institute Singapore, National Heart Centre Singapore, Singapore eBiomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Eric K W
authors.initials: EK
authors.lastname: Poon
authors.forename: Umair
authors.initials: U
authors.lastname: Hayat
authors.forename: Vikas
authors.initials: V
authors.lastname: Thondapu
authors.forename: Andrew S H
authors.initials: AS
authors.lastname: Ooi
authors.forename: Muhammad Asrar
authors.initials: MA
authors.lastname: Ul Haq
authors.forename: Stephen
authors.initials: S
authors.lastname: Moore
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
authors.forename: Shengxian
authors.initials: S
authors.lastname: Tu
authors.forename: Cheng
authors.initials: C
authors.lastname: Chin
authors.forename: Jason P
authors.initials: JP
authors.lastname: Monty
authors.forename: Ivan
authors.initials: I
authors.lastname: Marusic
authors.forename: Peter
authors.initials: P
authors.lastname: Barlis
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D003952:Diagnostic Imaging / Q000379:methods*; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D021621:Imaging, Three-Dimensional; D008955:Models, Cardiovascular; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D041623:Tomography, Optical Coherence; D016896:Treatment Outcome