One-Dimensional Mathematical Model-Based Automated Assessment of Fractional Flow Reserve in a Patient with Silent Myocardial Ischemia

Daria Gognieva, Timur Gamilov, Roman Pryamonosov, Vladimir Betelin, Sergey K Ternovoy, Natalya S Serova, Sergej Abugov, Dmitry Shchekochikhin, Yulia Mitina, Houssem El-Manaa, Philippe Kopylov, Daria Gognieva, Timur Gamilov, Roman Pryamonosov, Vladimir Betelin, Sergey K Ternovoy, Natalya S Serova, Sergej Abugov, Dmitry Shchekochikhin, Yulia Mitina, Houssem El-Manaa, Philippe Kopylov

Abstract

BACKGROUND Noninvasive assessment of the fractional flow reserve (FFR) in patients with coronary artery disease plays an important role in determining the need for revascularization. It is particularly relevant for patients with a borderline stenoses and painless myocardial ischemia. Our article describes the first clinical experience in the Russian Federation of using an automated method of noninvasive assessment of the fractional flow reserve (FFRct) with a one-dimensional (1-D) mathematical model in a patient with painless myocardial ischemia. CASE REPORT A 58-year-old male patient who underwent stent implantation in the left circumflex coronary artery (LCX) due to an acute non-ST-elevation posterior myocardial infarction had borderline stenoses of the left anterior descending artery (LAD). After stent implantation, there were no relapse angina symptoms on drug treatment, and according to our examination guideline for patients with borderline stenoses, a treadmill test was performed. The test was positive; therefore, FFR assessment was recommended, with coronary multi-slice CT being performed. The following results were obtained: FFRct LAD - 0.57; FFRct LCX - 0.88. An invasive assessment of FFR was also performed as a reference standard and revealed: FFR LAD - 0.6; FFR LCX - 0.88, and simultaneously a LAD percutaneous coronary intervention (PCI) was performed. Three months later, the patient underwent a stress test, which revealed no evidence of induced ischemia. CONCLUSIONS Our method of noninvasive assessment of FFR has shown encouraging results, but we believe that larger-scale studies are needed to establish it as common clinical practice.

Conflict of interest statement

Conflict of interest: None declared

Conflict of interest

None.

Figures

Figure 1.
Figure 1.
The source image in a DICOM format, where the visibility scope is narrowed in the upper cross-section. DICOM image had a resolution of 512×512×160 voxels, and voxel spatial size (spacing) was 0.5×0.5×1.0 mm.
Figure 2.
Figure 2.
3-D regions of the aorta and coronary vessels. RCA – the right coronary artery; LAD –the left anterior descending artery; LCX – the left circumflex coronary artery; S1,2 – stenosis 1 and 2.
Figure 3.
Figure 3.
A. One-dimensional mathematical model of coronary blood flow: FFRct LAD – 0.57; FFRct LCX – 0.88. B. Invasive assessment values: FFR LAD – 0.6; FFR LCX – 0.88.
Figure 4.
Figure 4.
An invasive assessment of FFR after stent implantation: FFR LAD – 0.86.

References

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