Quantification of fractional flow reserve based on angiographic image data

Jerry T Wong, Huy Le, William M Suh, David A Chalyan, Toufan Mehraien, Morton J Kern, Ghassan S Kassab, Sabee Molloi, Jerry T Wong, Huy Le, William M Suh, David A Chalyan, Toufan Mehraien, Morton J Kern, Ghassan S Kassab, Sabee Molloi

Abstract

Coronary angiography provides excellent visualization of coronary arteries, but has limitations in assessing the clinical significance of a coronary stenosis. Fractional flow reserve (FFR) has been shown to be reliable in discerning stenoses responsible for inducible ischemia. The purpose of this study is to validate a technique for FFR quantification using angiographic image data. The study was carried out on 10 anesthetized, closed-chest swine using angioplasty balloon catheters to produce partial occlusion. Angiography based FFR was calculated from an angiographically measured ratio of coronary blood flow to arterial lumen volume. Pressure-based FFR was measured from a ratio of distal coronary pressure to aortic pressure. Pressure-wire measurements of FFR (FFR( P )) correlated linearly with angiographic volume-derived measurements of FFR (FFR( V )) according to the equation: FFR( P ) = 0.41 FFR( V ) + 0.52 (P-value < 0.001). The correlation coefficient and standard error of estimate were 0.85 and 0.07, respectively. This is the first study to provide an angiographic method to quantify FFR in swine. Angiographic FFR can potentially provide an assessment of the physiological severity of a coronary stenosis during routine diagnostic cardiac catheterization without a need to cross a stenosis with a pressure-wire.

Figures

Fig. 1
Fig. 1
Continuous recording of pressures, flow velocity, and X-ray signal during (left) resting and (right) hyperemic flow
Fig. 2
Fig. 2
An example of a region-of-interest used for angiographic volume determination in epicardial arteries
Fig. 3
Fig. 3
An example of a global region-of-interest (ROI) used for angiographically measured coronary volume flow
Fig. 4
Fig. 4
A linear regression analysis of FFRP and FFRV measurements. The solid line represents the regression line (FFRP = 0.41 FFRV + 0.52; r = 0.85; SEE = 0.072). Standard errors in the slope and y-intercept values are 0.03 and 0.02, respectively
Fig. 5
Fig. 5
A linear regression analysis of FFRP and FFRQ measurements. The solid line represents the regression line (FFRP = 0.61 FFRQ + 0.52; r = 0.87; SEE = 0.070). Standard errors in the slope and y-intercept values are 0.03 and 0.02, respectively
Fig. 6
Fig. 6
Pooled data showing the relation between simplified myocardial fractional flow reserve (Pd/Pa) and direct flow reserve (QS/QN) in swine. Open circles represent data from the current study where FFRP is (Pd/Pa) and FFRQ is equivalent to (QS/QN). Closed triangles are extracted from published data by Pantely et al. [32, 34, 35] where blood flow was measured with Doppler flow probe

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