nach oben

Erschienen in:

03.05.2023 | Imaging Informatics and Artificial Intelligence

Diagnostic performance of angiography-derived fractional flow reserve analysis based on bifurcation fractal law for assessing hemodynamic significance of coronary stenosis

verfasst von: Hongbin Liang, Qiuxia Zhang, Yiting Gao, Guojun Chen, Yujia Bai, Yanan Zhang, Kai Cui, Qiancheng Wang, Shiping Cao, Yuqing Hou, Heye Zhang, Dhijnoo N. Ghista, Xiujian Liu, Jiancheng Xiu

Erschienen in: European Radiology | Ausgabe 10/2023

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Blood flow into the side branch affects the calculation of coronary angiography-derived fractional flow reserve (FFR), called Angio-FFR. Neglecting or improperly compensating for the side branch flow may decrease the diagnostic accuracy of Angio-FFR. This study aims to evaluate the diagnostic accuracy of a novel Angio-FFR analysis that considers the side branch flow based on the bifurcation fractal law.

Methods

A one-dimensional reduced-order model based on the vessel segment was used to perform Angio-FFR analysis. The main epicardial coronary artery was divided into several segments according to the bifurcation nodes. Side branch flow was quantified using the bifurcation fractal law to correct the blood flow in each vessel segment. In order to verify the diagnostic performance of our Angio-FFR analysis, two other computational methods were taken as control groups: (i) FFR_s: FFR calculated by delineating the coronary artery tree to consider side branch flow, (ii) FFR_n: FFR calculated by just delineating the main epicardial coronary artery and neglecting the side branch flow.

Results

The analysis of 159 vessels from 119 patients showed that our Anio-FFR calculation method had comparable diagnostic accuracy to FFR_s and provided significantly higher diagnostic accuracy than that of FFR_n. In addition, using invasive FFR as a reference, the Pearson correlation coefficients of Angio-FFR and FFRs were 0.92 and 0.91, respectively, while that of FFR_n was only 0.85.

Conclusions

Our Angio-FFR analysis has demonstrated good diagnostic performance in assessing the hemodynamic significance of coronary stenosis by using the bifurcation fractal law to compensate for side branch flow.

Clinical relevance statement

Bifurcation fractal law can be used to compensate for side branch flow during the Angio-FFR calculation of the main epicardial vessel. Compensating for side branch flow can improve the ability of Angio-FFR to diagnose stenosis functional severity.

Key Points

• The bifurcation fractal law could accurately estimate the blood flow from the proximal main vessel into the main branch, thus compensating for the side branch flow.

• Angiography-derived FFR based on the bifurcation fractal law is feasible to evaluate the target diseased coronary artery without delineating the side branch.

Nur mit Berechtigung zugänglich

Stergiopoulos K, Boden WE, Hartigan P et al (2014) Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med 174(2):232–240CrossRefPubMed

Shaw LJ, Weintraub WS, Maron DJ et al (2012) Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J 164(2):243–250CrossRefPubMed

Kogame N, Ono M, Kawashima H et al (2020) The impact of coronary physiology on contemporary clinical decision making. JACC Cardiovasc Interv 13(14):1617–1638CrossRefPubMed

Neumann FJ, Sousa-Uva M, Ahlsson A et al (2019) 2018 esc/eacts guidelines on myocardial revascularization. Eur Heart J 40(2):87–165CrossRefPubMed

Maria GL, Garcia-Garcia HM, Scarsini R et al (2020) Novel indices of coronary physiology: do we need alternatives to fractional flow reserve? Circ Cardiovasc Inte 13(4):e008487CrossRef

Ramasamy A, Jin C, Tufaro V et al (2020) Computerised methodologies for non-invasive angiography-derived fractional flow reserve assessment: a critical review. J Interv Cardiol 6381637

Collet C, Onuma Y, Sonck J et al (2018) Diagnostic performance of angiography-derived fractional flow reserve: a systematic review and Bayesian meta-analysis. Eur Heart J 39(35):3314–3321CrossRefPubMed

Takahashi T, Shin D, Kuno T et al (2022) Diagnostic performance of coronary angiography- and intravascular imaging-based fractional flow reserve to detect functionally significant coronary stenoses: a systemic review and meta-analysis. J Am Coll Cardiol 79(9s):838–838CrossRef

Xu B, Tu S, Song L et al (2021) Angiographic quantitative flow ratio-guided coronary intervention (favor iii china): a multicentre, randomised, sham-controlled trial. Lancet 398(10317):2149–2159CrossRefPubMed

10.

Li Y, Guti´errez-Chico JL, Holm NR et al (2015) Impact of side branch modeling on computation of endothelial shear stress in coronary artery disease: coronary tree reconstruction by fusion of 3d angiography and oct. J Am Coll Cardiol 66(2):125–135CrossRefPubMed

11.

Choi KH, Dai N, Li Y et al (2021) Functional coronary angiography–derived index of microcirculatory resistance in patients with st-segment elevation myocardial infarction. JACC Cardiovasc Interv 14(15):1670–1684CrossRefPubMed

12.

Papafaklis MI, Muramatsu T, Ishibashi Y et al (2014) 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 10(5):574–583CrossRefPubMed

13.

Kornowski R, Lavi I, Pellicano M et al (2016) Fractional flow reserve derived from routine coronary angiograms. J Am Coll Cardiol 68(20):2235–2237CrossRefPubMed

14.

Tu S, Barbato E, Ko¨szegi Z et al (2014) 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 7(7):768–777CrossRefPubMed

15.

Tu S, Westra J, Yang J et al (2016) (2016) Diagnostic accuracy of fast computational approaches to derive fractional flow reserve from diagnostic coronary angiography: the international multicenter favor pilot study. JACC Cardiovasc Interv 9(19):2024–2035CrossRefPubMed

16.

Gibson CM, Cannon CP, Daley WL et al (1996) Timi frame count: a quantitative method of assessing coronary artery flow. Circulation 93(5):879–888CrossRefPubMed

17.

Zhang H, Zhang D, Gao Z, Zhang H (2021) Joint segmentation and quantification of main coronary vessels using dual-branch multi-scale attention network. Int Conf Med Image Comput Comput-Assist Interv 369–378

18.

Greenspan H, Laifenfeld M, Einav S, Barnea O (2001) Evaluation of center-line extraction algorithms in quantitative coronary angiography. IEEE Trans Med Imaging 20(9):928–941CrossRefPubMed

19.

Zhang Y, Zhang S, Westra J et al (2019) Automatic coronary blood flow computation: validation in quantitative flow ratio from coronary angiography. Int J Cardiovas Imag 35(4):587–595CrossRef

20.

Huo Y, Kassab GS (2009) A scaling law of vascular volume. Biophys J 96(2):347–353CrossRefPubMedPubMedCentral

21.

Huo Y, Finet G, Lefèvre T, Louvard Y, Moussa I, Kassab GS (2012) Optimal diameter of diseased bifurcation segment: a practical rule for percutaneous coronary intervention. EuroIntervention 7(11):1310–1316

22.

Liu X, Xu C, Rao S et al (2022) Physiologically personalized coronary blood flow model to improve the estimation of noninvasive fractional flow reserve. Med Phys 49(1):583–597CrossRefPubMed

23.

Gosling RC, Sturdy J, Morris PD et al (2020) Effect of side branch flow upon physiological indices in coronary artery disease. J Biomech 103:109698CrossRefPubMed

24.

Tu S, Ding D, Chang Y, Li C, Wijns W, Xu B (2021) Diagnostic accuracy of quantitative flow ratio for assessment of coronary stenosis significance from a single angiographic view: a novel method based on bifurcation fractal law. Catheter Cardio Inte 97:1040–1047CrossRef

25.

Yu W, Tanigaki T, Ding D et al (2021) Accuracy of intravascular ultrasound-based fractional flow reserve in identifying hemodynamic significance of coronary stenosis. Circ Cardiovasc Inte 14(2):e009840CrossRef

26.

Murray CD (1926) The physiological principle of minimum work: I. the vascular system and the cost of blood volume. Proc Natl Acad Sci U S A 12(3):207–214CrossRef

27.

Finet G, Gilard N, Perrenot B et al (2008) Fractal geometry of arterial coronary bifurcations: a quantitative coronary angiography and intravascular ultrasound analysis. EuroIntervention 3(4):490–498CrossRefPubMed

28.

D´erimay F, Kassab GS, Finet G (2021) Structure-function relation in the coronary artery tree: theory and applications in interventional cardiology. Biomechanics of Coronary Atherosclerotic Plaque. Academic Press 545– 554

29.

Blanco PJ, Bulant CA, M ̈uller LO et al (2018) Comparison of 1d and 3d models for the estimation of fractional flow reserve. Sci rep 8(1):1–12

30.

Young DF, Tsai FY (1973) Flow characteristics in models of arterial stenoses—ii. unsteady flow. J Biomech 6(5):547–559CrossRefPubMed

31.

Hajian-Tilaki K (2014) Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform 48:193–204CrossRefPubMed

32.

Koo BK, Kang HJ, Youn TJ et al (2015) Physiologic assessment of jailed side branch lesions using fractional flow reserve. J Am Coll Cardiol 46:633–637CrossRef

33.

DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845CrossRefPubMed

34.

Shahzad R, Kirişli H, Metz C et al (2013) Automatic segmentation, detection and quantification of coronary artery stenoses on CTA. Int J Cardiovas Imag 29(8):1847–1859CrossRef

35.

Pijls NH, De Bruyne B, Peels K et al (1996) Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med 334(26):1703–1708CrossRefPubMed

Titel: Diagnostic performance of angiography-derived fractional flow reserve analysis based on bifurcation fractal law for assessing hemodynamic significance of coronary stenosis
verfasst von: Hongbin Liang
Qiuxia Zhang
Yiting Gao
Guojun Chen
Yujia Bai
Yanan Zhang
Kai Cui
Qiancheng Wang
Shiping Cao
Yuqing Hou
Heye Zhang
Dhijnoo N. Ghista
Xiujian Liu
Jiancheng Xiu
Publikationsdatum: 03.05.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 10/2023
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-023-09682-1

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Klimawandel und Gesundheit: Was Sie in der Hausarztpraxis wissen müssen und tun können

Springer Medizin

Diagnostic performance of angiography-derived fractional flow reserve analysis based on bifurcation fractal law for assessing hemodynamic significance of coronary stenosis