title: Comparison of Fractional Flow Reserve Based on Computational Fluid Dynamics Modeling Using Coronary Angiographic Vessel Morphology Versus Invasively Measured Fractional Flow Reserve.
abstract: Invasive fractional flow reserve (FFRinvasive), although gold standard to identify hemodynamically relevant coronary stenoses, is time consuming and potentially associated with complications. We developed and evaluated a new approach to determine lesion-specific FFR on the basis of coronary anatomy as visualized by invasive coronary angiography (FFRangio): 100 coronary lesions (50% to 90% diameter stenosis) in 73 patients (48 men, 25 women; mean age 67 ± 9 years) were studied. On the basis of coronary angiograms acquired at rest from 2 views at angulations at least 30° apart, a PC-based computational fluid dynamics modeling software used personalized boundary conditions determined from 3-dimensional reconstructed angiography, heart rate, and blood pressure to derive FFRangio. The results were compared with FFRinvasive. Interobserver variability was determined in a subset of 25 narrowings. Twenty-nine of 100 coronary lesions were hemodynamically significant (FFRinvasive ≤ 0.80). FFRangio identified these with an accuracy of 90%, sensitivity of 79%, specificity of 94%, positive predictive value of 85%, and negative predictive value of 92%. The area under the receiver operating characteristic curve was 0.93. Correlation between FFRinvasive (mean: 0.84 ± 0.11) and FFRangio (mean: 0.85 ± 0.12) was r = 0.85. Interobserver variability of FFRangio was low, with a correlation of r = 0.88. In conclusion, estimation of coronary FFR with PC-based computational fluid dynamics modeling on the basis of lesion morphology as determined by invasive angiography is possible with high diagnostic accuracy compared to invasive measurements.
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Monique
authors.initials: M
authors.lastname: Tröbs
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany. Electronic address: stephan.achenbach@uk-erlangen.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Röther
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Redel
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Scheuering
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Winneberger
authors.affiliation: Siemens Healthcare GmbH, Forchheim, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Klingenbeck
authors.affiliation: Siemens Corporate Technology, Brasov, Romania.
authors.forename: Lucian
authors.initials: L
authors.lastname: Itu
authors.affiliation: Siemens Medical Solutions USA, Inc., Princeton, New Jersey.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Passerini
authors.affiliation: Siemens Medical Solutions USA, Inc., Princeton, New Jersey.
authors.forename: Ali
authors.initials: A
authors.lastname: Kamen
authors.affiliation: Siemens Medical Solutions USA, Inc., Princeton, New Jersey.
authors.forename: Puneet
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Siemens Medical Solutions USA, Inc., Princeton, New Jersey.
authors.forename: Dorin
authors.initials: D
authors.lastname: Comaniciu
authors.affiliation: Department of Cardiology, University of Erlangen, Erlangen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlundt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed