Please use this identifier to cite or link to this item: https://doi.org/10.3389/fbioe.2021.739667
Title: Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention
Authors: Chandola, Gaurav
Zhang, Jun-Mei
Tan, Ru-San
Chai, Ping 
Teo, Lynette 
Allen, John C 
Low, Ris
Huang, Weimin
Leng, Shuang 
Fam, Jiang Ming 
Chin, Chee Yang 
Kassab, Ghassan S
Low, Adrian Fatt Hoe 
Tan, Swee Yaw 
Chua, Terrance 
Lim, Soo Teik 
Zhong, Liang 
Keywords: Science & Technology
Life Sciences & Biomedicine
Biotechnology & Applied Microbiology
Multidisciplinary Sciences
Science & Technology - Other Topics
fractional flow reserve
stents
hemodynamics
coronary angiography
computed tomography angiography
BLOOD-FLOW
NONINVASIVE QUANTIFICATION
DIAGNOSTIC PERFORMANCE
CT ANGIOGRAPHY
ISCHEMIA
ARTERY
STENOSES
Issue Date: 7-Sep-2021
Publisher: FRONTIERS MEDIA SA
Citation: Chandola, Gaurav, Zhang, Jun-Mei, Tan, Ru-San, Chai, Ping, Teo, Lynette, Allen, John C, Low, Ris, Huang, Weimin, Leng, Shuang, Fam, Jiang Ming, Chin, Chee Yang, Kassab, Ghassan S, Low, Adrian Fatt Hoe, Tan, Swee Yaw, Chua, Terrance, Lim, Soo Teik, Zhong, Liang (2021-09-07). Computed Tomography Coronary Angiography and Computational Fluid Dynamics Based Fractional Flow Reserve Before and After Percutaneous Coronary Intervention. FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY 9. ScholarBank@NUS Repository. https://doi.org/10.3389/fbioe.2021.739667
Abstract: Invasive fractional flow reserve (FFR) is recommended to guide stent deployment. We previously introduced a non-invasive FFR calculation (FFRB) based on computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamics (CFD) and resistance boundary conditions. Current study aimed to assess the feasibility and accuracy of FFRB for predicting coronary hemodynamics before and after stenting, with invasive FFR as the reference. Twenty-five patients who had undergone CTCA were prospectively enrolled before invasive coronary angiography (ICA) and FFR-guided percutaneous coronary intervention (PCI) on 30 coronary vessels. Using reduced-order CFD with novel boundary conditions on three-dimensional (3D) patient-specific anatomic models reconstructed from CTCA, we calculated FFRB before and after virtual stenting. The latter simulated PCI by clipping stenotic segments from the 3D coronary models and replacing them with segments to mimic the deployed coronary stents. Pre- and post-virtual stenting FFRB were compared with FFR measured pre- and post-PCI by investigators blinded to FFRB results. Among 30 coronary lesions, pre-stenting FFRB (mean 0.69 ± 0.12) and FFR (mean 0.67 ± 0.13) exhibited good correlation (r = 0.86, p < 0.001) and agreement [mean difference 0.024, 95% limits of agreement (LoA): -0.11, 0.15]. Similarly, post-stenting FFRB (mean 0.84 ± 0.10) and FFR (mean 0.86 ± 0.08) exhibited fair correlation (r = 0.50, p < 0.001) and good agreement (mean difference 0.024, 95% LoA: -0.20, 0.16). The accuracy of FFRB for identifying post-stenting ischemic lesions (FFR ≤ 0.8) (residual ischemia) was 87% (sensitivity 80%, specificity 88%). Our novel FFRB, based on CTCA with reduced-order CFD and resistance boundary conditions, accurately predicts the hemodynamic effects of stenting which may serve as a tool in PCI planning.
Source Title: FRONTIERS IN BIOENGINEERING AND BIOTECHNOLOGY
URI: https://scholarbank.nus.edu.sg/handle/10635/208536
ISSN: 22964185
DOI: 10.3389/fbioe.2021.739667
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