Comparison of 1D and 3D Models for the Estimation of Fractional Flow Reserve

P J Blanco,P A Lemos,C A Bulant,R A Feijóo,C Guedes Bezerra,G D Maso Talou,L O Müller

doi:10.1038/s41598-018-35344-0

P J Blanco, P A Lemos + Show 5 more

Open Access

https://doi.org/10.1038/s41598-018-35344-0

Copy DOI

Abstract

In this work we propose to validate the predictive capabilities of one-dimensional (1D) blood flow models with full three-dimensional (3D) models in the context of patient-specific coronary hemodynamics in hyperemic conditions. Such conditions mimic the state of coronary circulation during the acquisition of the Fractional Flow Reserve (FFR) index. Demonstrating that 1D models accurately reproduce FFR estimates obtained with 3D models has implications in the approach to computationally estimate FFR. To this end, a sample of 20 patients was employed from which 29 3D geometries of arterial trees were constructed, 9 obtained from coronary computed tomography angiography (CCTA) and 20 from intra-vascular ultrasound (IVUS). For each 3D arterial model, a 1D counterpart was generated. The same outflow and inlet pressure boundary conditions were applied to both (3D and 1D) models. In the 1D setting, pressure losses at stenoses and bifurcations were accounted for through specific lumped models. Comparisons between 1D models (FFR1D) and 3D models (FFR3D) were performed in terms of predicted FFR value. Compared to FFR3D, FFR1D resulted with a difference of 0.00 ± 0.03 and overall predictive capability AUC, Acc, Spe, Sen, PPV and NPV of 0.97, 0.98, 0.90, 0.99, 0.82, and 0.99, with an FFR threshold of 0.8. We conclude that inexpensive FFR1D simulations can be reliably used as a surrogate of demanding FFR3D computations.

Highlights

In this work we propose to validate the predictive capabilities of one-dimensional (1D) blood flow models with full three-dimensional (3D) models in the context of patient-specific coronary hemodynamics in hyperemic conditions
By taking FFR3D as the reference solution, we report the prevalence (Prev), and classification indexes such as the area under the receiver operating characteristic curve (AUC), accuracy (Acc), sensitivity (Sen), specificity (Spe), positive predictive value (PPV) and negative predictive value (NPV) for the FFR1D computed in different scenarios
4P, we observe that all 1D model scenarios provide excellent classification capabilities when compared to the 3D model

Summary

Introduction

In this work we propose to validate the predictive capabilities of one-dimensional (1D) blood flow models with full three-dimensional (3D) models in the context of patient-specific coronary hemodynamics in hyperemic conditions. Fractional Flow Reserve (FFR) is a hemodynamic index aimed at the quantification of the functional severity of a coronary artery stenosis This index, which is calculated from pressure measurements and under hyperemic conditions, has been proposed and used to detect myocardial ischemia[1,2], and has largely demonstrated excellent results as a diagnostic tool to defer patients with intermediate lesions to surgical procedures[3,4,5]. A myriad of different approaches using image modalities such as coronary computed tomography angiography (CCTA)[6], angiography (AX)[7], and even optical coherence tomography (OCT)[8], emerged These approaches employ 3D models to estimate pressure losses in coronary vessels and to devise a strategy to predict patient-specific FFR. Baseline clinical characteristic Age, yrs Male BMI, kg/m2 Weight, Kg Height, cm HR, bpm SP, mmHg DP, mmHg MP, mmHg Circulation Dominance Right Left Co

Objectives

Methods

Results

Conclusion