A modified method of noninvasive computed tomography derived fractional flow reserve based on the microvascular growth space

Wei He; Long Yu; Wang Qin; Yuan Wang; Keqiang Wang; Weifeng Guo; Shengzhang Wang

doi:10.1016/j.cmpb.2022.106926

A modified method of noninvasive computed tomography derived fractional flow reserve based on the microvascular growth space

Comput Methods Programs Biomed. 2022 Jun:221:106926. doi: 10.1016/j.cmpb.2022.106926. Epub 2022 Jun 2.

Authors

Wei He¹, Long Yu², Wang Qin², Yuan Wang³, Keqiang Wang⁴, Weifeng Guo⁵, Shengzhang Wang⁶

Affiliations

¹ Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
² Department of aeronautics and astronautics, Fudan University, Shanghai, China.
³ School of Basic Medical Sciences, Fudan University, Shanghai, China.
⁴ Institute of Panvascular Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
⁵ Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China. Electronic address: guo.weifeng@zs-hospital.sh.cn.
⁶ Department of aeronautics and astronautics, Fudan University, Shanghai, China; Institute of Biomedical Engineering Technology, Academy for Engineering and Technology, Fudan University, Shanghai, China; Yiwu Research Institute, Fudan University, Yiwu, China. Electronic address: szwang@fudan.edu.cn.

PMID: 35701250
DOI: 10.1016/j.cmpb.2022.106926

Abstract

Objective: To establish a modified method for optimizing outlet boundary conditions (BC) of computed tomography-derived fractional flow reserve (CT-FFR), considering the myocardium as a growth space for microcirculation. The feasibility and diagnostic performance of the modified method in stable coronary artery disease (CAD) were compared with invasive fractional flow reserve (FFR).

Methods: Nineteen patients (19 lesions) underwent coronary computed tomography angiography (CCTA) and following invasive FFR were included. The microcirculation resistance model generated based on patient-specific anatomical structures and physiological principles was used as the outlet BC, considering the myocardium as a growth space. Brachial artery pressure (BAP) plus or minus 10 mmHg was used as the inlet pressure BC to investigate the effect of the circadian rhythm. After simulation, CT-FFR was compared with invasive FFR with a threshold of 0.80.

Results: Compared with invasive FFR, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT-FFR with an optimal threshold of 0.80 were 100%, 100%, 100%, 100%, 100%, respectively. There were a good correlation and consistency between CT-FFR and invasive FFR. Little effect of the circadian fluctuation of BAP was found on the simulation.

Conclusions: A modified method for CT-FFR with high diagnostic accuracy compared with invasive FFR was established, considering the whole myocardial as the growth space for microcirculation. Circadian fluctuations in BAP could be ignored when it was used as the inlet BC.

Keywords: Circadian fluctuation; Coronary artery disease; Coronary computed tomography angiography; Fractional flow reserve; Microcirculation resistance model.

MeSH terms

Computed Tomography Angiography / methods
Coronary Angiography / methods
Coronary Artery Disease* / diagnostic imaging
Coronary Stenosis*
Fractional Flow Reserve, Myocardial* / physiology
Humans
Predictive Value of Tests
Tomography, X-Ray Computed