title: Simplified Models of Non-Invasive Fractional Flow Reserve Based on CT Images.
abstract: Invasive fractional flow reserve (FFR) is the gold standard to assess the functional coronary stenosis. The non-invasive assessment of diameter stenosis (DS) using coronary computed tomography angiography (CTA) has high false positive rate in contrast to FFR. Combining CTA with computational fluid dynamics (CFD), recent studies have shown promising predictions of FFRCT for superior assessment of lesion severity over CTA alone. The CFD models tend to be computationally expensive, however, and require several hours for completing analysis. Here, we introduce simplified models to predict noninvasive FFR at substantially less computational time. In this retrospective pilot study, 21 patients received coronary CTA. Subsequently a total of 32 vessels underwent invasive FFR measurement. For each vessel, FFR based on steady-state and analytical models (FFRSS and FFRAM, respectively) were calculated non-invasively based on CTA and compared with FFR. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value were 90.6% (87.5%), 80.0% (80.0%), 95.5% (90.9%), 88.9% (80.0%) and 91.3% (90.9%) respectively for FFRSS (and FFRAM) on a per-vessel basis, and were 75.0%, 50.0%, 86.4%, 62.5% and 79.2% respectively for DS. The area under the receiver operating characteristic curve (AUC) was 0.963, 0.954 and 0.741 for FFRSS, FFRAM and DS respectively, on a per-patient level. The results suggest that the CTA-derived FFRSS performed well in contrast to invasive FFR and they had better diagnostic performance than DS from CTA in the identification of functionally significant lesions. In contrast to FFRCT, FFRSS requires much less computational time.
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Jun-Mei
authors.initials: JM
authors.lastname: Zhang
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhong
authors.affiliation: California Medical Innovations Institute, San Diego, CA 92121, United States of America.
authors.forename: Tong
authors.initials: T
authors.lastname: Luo
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
authors.forename: Aileen Mae
authors.initials: AM
authors.lastname: Lomarda
authors.affiliation: Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, 100871, China.
authors.forename: Yunlong
authors.initials: Y
authors.lastname: Huo
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yap
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Soo Teik
authors.initials: ST
authors.lastname: Lim
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Ru San
authors.initials: RS
authors.lastname: Tan
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Aaron Sung Lung
authors.initials: AS
authors.lastname: Wong
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Jack Wei Chieh
authors.initials: JW
authors.lastname: Tan
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Khung Keong
authors.initials: KK
authors.lastname: Yeo
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
authors.forename: Jiang Ming
authors.initials: JM
authors.lastname: Fam
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Felix Yung Jih
authors.initials: FY
authors.lastname: Keng
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|School of Information Engineering, Nanchang University, Nanchang, Jiangxi, 330031, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wan
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
authors.forename: Boyang
authors.initials: B
authors.lastname: Su
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.
authors.forename: Xiaodan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: John Carson
authors.initials: JC
authors.lastname: Allen
authors.affiliation: California Medical Innovations Institute, San Diego, CA 92121, United States of America.
authors.forename: Ghassan S
authors.initials: GS
authors.lastname: Kassab
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Terrance Siang Jin
authors.initials: TS
authors.lastname: Chua
authors.affiliation: National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore.|Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore.
authors.forename: Swee Yaw
authors.initials: SY
authors.lastname: Tan
mesh_terms: D000368:Aged; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010865:Pilot Projects; D014057:Tomography, X-Ray Computed