Noninvasive CT-based hemodynamic assessment of coronary lesions derived from fast computational analysis: a comparison against fractional flow reserve
Application of computational fluid dynamics (CFD) to three-dimensional CTCA datasets has been shown to provide accurate assessment of the hemodynamic significance of a coronary lesion. We aim to test the feasibility of calculating a novel CTCA-based virtual functional assessment index (vFAI) of coronary stenoses > 30% and ≤ 90% by using an automated in-house-developed software and to evaluate its efficacy as compared to the invasively measured fractional flow reserve (FFR).
Methods and results
In 63 patients with chest pain symptoms and intermediate (20–90%) pre-test likelihood of coronary artery disease undergoing CTCA and invasive coronary angiography with FFR measurement, vFAI calculations were performed after 3D reconstruction of the coronary vessels and flow simulations using the finite element method. A total of 74 vessels were analyzed. Mean CTCA processing time was 25(± 10) min. There was a strong correlation between vFAI and FFR, (R = 0.93, p < 0.001) and a very good agreement between the two parameters by the Bland–Altman method of analysis. The mean difference of measurements from the two methods was 0.03 (SD = 0.033), indicating a small systematic overestimation of the FFR by vFAI. Using a receiver-operating characteristic curve analysis, the optimal vFAI cutoff value for identifying an FFR threshold of ≤ 0.8 was ≤ 0.82 (95% CI 0.81 to 0.88).
vFAI can be effectively derived from the application of computational fluid dynamics to three-dimensional CTCA datasets. In patients with coronary stenosis severity > 30% and ≤ 90%, vFAI performs well against FFR and may efficiently distinguish between hemodynamically significant from non-significant lesions.
Virtual functional assessment index (vFAI) can be effectively derived from 3D CTCA datasets.
In patients with coronary stenoses severity > 30% and ≤ 90%, vFAI performs well against FFR.
vFAI may efficiently distinguish between functionally significant from non-significant lesions.
KeywordsCoronary artery disease Myocardial fractional flow reserve Computed tomography angiography
Coronary artery calcium score
Coronary artery disease
Computational fluid dynamics
Computed tomography coronary angiography
Fractional flow reserve
Invasive coronary angiography
Virtual functional assessment index
This work was supported in part by European Union FP7-CP-FP506 2007 (grant no. 222915) (EVINCI study) and in part by European Union’s Horizon 2020 research and innovation program under grant agreement no. 689068 (SMARTool study).
Compliance with ethical standards
The scientific guarantor of this publication is Constantinos D. Anagnostopoulos.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
No complex statistical methods were necessary for this paper.
In the context of the EVINCI study (Neglia D et al Circ Cardiovasc Imaging. 2015 Mar;8(3). pii: e002179. doi: https://doi.org/10.1161/CIRCIMAGING.114.002179), ethical approval was provided by each participating center and all subjects gave written informed consent. For the present study investigating anonymized imaging data, informed consent was waived.
Institutional Review Board approval was obtained.
• diagnostic or prognostic study
• multicenter study
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