Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis: Results From the VIRTU-Fast Study

Overview

Journal JACC Basic Transl Sci

Date 2017 Sep 19

PMID 28920099

Citations 39

Authors

Paul D Morris

Daniel Alejandro Silva Soto

Jeroen F A Feher

Dan Rafiroiu

Angela Lungu

Susheel Varma

Patricia V Lawford

D Rodney Hose

Julian P Gunn

Affiliations

Soon will be listed here.

Abstract

Fractional flow reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel "pseudotransient" analysis protocol for computing virtual fractional flow reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33%) and more by microvascular physiology (59%). If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.

Citing Articles

Uncertainty Quantification and Sensitivity Analysis for Non-invasive Model-Based Instantaneous Wave-Free Ratio Prediction.

Dalmaso C, Fossan F, Braten A, Muller L Int J Numer Method Biomed Eng. 2025; 41(1):e3898.

PMID: 39777995 PMC: 11706247. DOI: 10.1002/cnm.3898.

Overview of Quantitative Flow Ratio and Optical Flow Ratio in the Assessment of Intermediate Coronary Lesions.

Westra J, Tu S US Cardiol. 2024; 14:e09.

PMID: 39720454 PMC: 11664755. DOI: 10.15420/usc.2020.09.

Current and Future Applications of Computational Fluid Dynamics in Coronary Artery Disease.

Candreva A, De Nisco G, Lodi Rizzini M, DAscenzo F, De Ferrari G, Gallo D Rev Cardiovasc Med. 2024; 23(11):377.

PMID: 39076179 PMC: 11269074. DOI: 10.31083/j.rcm2311377.

Patient-specific 3D coronary model in cardiac catheterisation laboratories.

Lashgari M, Choudhury R, Banerjee A Front Cardiovasc Med. 2024; 11:1398290.

PMID: 39036504 PMC: 11257904. DOI: 10.3389/fcvm.2024.1398290.

Diagnostic Performance of Coronary Angiography Derived Computational Fractional Flow Reserve.

Vardhan M, Tanade C, Chen S, Mahmood O, Chakravartti J, Jones W J Am Heart Assoc. 2024; 13(13):e029941.

PMID: 38904250 PMC: 11255717. DOI: 10.1161/JAHA.123.029941.

References

Kappetein A, Dawkins K, Mohr F, Morice M, Mack M, Russell M . Current percutaneous coronary intervention and coronary artery bypass grafting practices for three-vessel and left main coronary artery disease. Insights from the SYNTAX run-in phase. Eur J Cardiothorac Surg. 2006; 29(4):486-91. DOI: 10.1016/j.ejcts.2006.01.047. View

Gorlin R, GORLIN S . Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J. 1951; 41(1):1-29. DOI: 10.1016/0002-8703(51)90002-6. View

Morris P, van de Vosse F, Lawford P, Hose D, Gunn J . "Virtual" (Computed) Fractional Flow Reserve: Current Challenges and Limitations. JACC Cardiovasc Interv. 2015; 8(8):1009-1017. PMC: 4726733. DOI: 10.1016/j.jcin.2015.04.006. View

Pijls N, Fearon W, Tonino P, Siebert U, Ikeno F, Bornschein B . Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study. J Am Coll Cardiol. 2010; 56(3):177-84. DOI: 10.1016/j.jacc.2010.04.012. View

Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M . Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv. 2016; 9(19):2024-2035. DOI: 10.1016/j.jcin.2016.07.013. View

Koo B, Yang H, Doh J, Choe H, Lee S, Yoon C . Optimal intravascular ultrasound criteria and their accuracy for defining the functional significance of intermediate coronary stenoses of different locations. JACC Cardiovasc Interv. 2011; 4(7):803-11. DOI: 10.1016/j.jcin.2011.03.013. View

Morris P, Ryan D, Morton A, Lycett R, Lawford P, Hose D . Virtual fractional flow reserve from coronary angiography: modeling the significance of coronary lesions: results from the VIRTU-1 (VIRTUal Fractional Flow Reserve From Coronary Angiography) study. JACC Cardiovasc Interv. 2013; 6(2):149-57. DOI: 10.1016/j.jcin.2012.08.024. View

Zeng D, Boutsianis E, Ammann M, Boomsma K, Wildermuth S, Poulikakos D . A study on the compliance of a right coronary artery and its impact on wall shear stress. J Biomech Eng. 2008; 130(4):041014. DOI: 10.1115/1.2937744. View

Wu C, Hannan E, Walford G, Ambrose J, Holmes Jr D, King 3rd S . A risk score to predict in-hospital mortality for percutaneous coronary interventions. J Am Coll Cardiol. 2006; 47(3):654-60. DOI: 10.1016/j.jacc.2005.09.071. View

10.

Lungu A, Wild J, Capener D, Kiely D, Swift A, Hose D . MRI model-based non-invasive differential diagnosis in pulmonary hypertension. J Biomech. 2014; 47(12):2941-7. DOI: 10.1016/j.jbiomech.2014.07.024. View

11.

Pijls N, van Son J, Kirkeeide R, de Bruyne B, Gould K . Experimental basis of determining maximum coronary, myocardial, and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993; 87(4):1354-67. DOI: 10.1161/01.cir.87.4.1354. View

12.

Tu S, Barbato E, Koszegi Z, Yang J, Sun Z, Holm N . Fractional flow reserve calculation from 3-dimensional quantitative coronary angiography and TIMI frame count: a fast computer model to quantify the functional significance of moderately obstructed coronary arteries. JACC Cardiovasc Interv. 2014; 7(7):768-77. DOI: 10.1016/j.jcin.2014.03.004. View

13.

De Bruyne B, Pijls N, Kalesan B, Barbato E, Tonino P, Piroth Z . Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease. N Engl J Med. 2012; 367(11):991-1001. DOI: 10.1056/NEJMoa1205361. View

14.

de Bruyne B, Bartunek J, Sys S, Pijls N, Heyndrickx G, Wijns W . Simultaneous coronary pressure and flow velocity measurements in humans. Feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. Circulation. 1996; 94(8):1842-9. DOI: 10.1161/01.cir.94.8.1842. View

15.

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

16.

Levine G, Bates E, Blankenship J, Bailey S, Bittl J, Cercek B . 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and.... J Am Coll Cardiol. 2011; 58(24):e44-122. DOI: 10.1016/j.jacc.2011.08.007. View

17.

Norgaard B, Leipsic J, Gaur S, Seneviratne S, Ko B, Ito H . Diagnostic performance of noninvasive fractional flow reserve derived from coronary computed tomography angiography in suspected coronary artery disease: the NXT trial (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps). J Am Coll Cardiol. 2014; 63(12):1145-1155. DOI: 10.1016/j.jacc.2013.11.043. View

18.

Dehmer G, Weaver D, Roe M, Milford-Beland S, Fitzgerald S, Hermann A . A contemporary view of diagnostic cardiac catheterization and percutaneous coronary intervention in the United States: a report from the CathPCI Registry of the National Cardiovascular Data Registry, 2010 through June 2011. J Am Coll Cardiol. 2012; 60(20):2017-31. DOI: 10.1016/j.jacc.2012.08.966. View

19.

Windecker S, Kolh P, Alfonso F, Collet J, Cremer J, Falk V . 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special.... Eur Heart J. 2014; 35(37):2541-619. DOI: 10.1093/eurheartj/ehu278. View

20.

Papafaklis M, Muramatsu T, Ishibashi Y, Lakkas L, Nakatani S, Bourantas C . Fast virtual functional assessment of intermediate coronary lesions using routine angiographic data and blood flow simulation in humans: comparison with pressure wire - fractional flow reserve. EuroIntervention. 2014; 10(5):574-83. DOI: 10.4244/EIJY14M07_01. View