Optimal treatment planning for borderline coronary lesions using noninvasive computed fractional flow reserve

Abstract

Purpose: To compare diagnostic performance of standard invasive fractional flow reserve (FFR) with noninvasive computed FFR (FFRct) angiogram patient data and to assess the impact of FFRct on treatment decision-making using virtual stenting. Methods: Three patients admitted for coronary artery disease underwent coronary CT angiography (Siemens 256-slice SOMATOM Definition CT scanner) and cardiac catheterization with FFR assessment. Internally designed software was used for computer simulation of FFR based on the coronary CT angiogram. The 3D blood flow was described by the Navier-Stokes equations, in conjunction with the continuity equation. A parabolic flow waveform was applied at the location of aortic root, while outlet boundary conditions were configured to an inverse diameter resistance. Results: Coronary CT angiography discovered that 2 patients had single vessel coronary artery disease (CAD) with significant stenosis (>50%) observed on ACD and LAD respectively, and one patient had triple vessel CAD. There was no difference between the FFR and FFRct values (p>0.22). Coronary CT angiogram designated 2 lesions as significant and after performing FFRct both of these lesions were discarded as functionally insignificant. Virtual stenting was performed in 2 patients demonstrating significant improvement in flow dynamics and appropriate FFRct values distal to the lesion. ![Figure][1] Noninvasive FFR Conclusions: We found a solid correlation between FFR and FFRct results. Computer simulation may offer distinct advantage due to non-invasive nature of the analysis, and as such may prove to be of particular benefit when assessing borderline cardiac patients. FFRct can simulate and accurately predict the effect of coronary artery stenting, thus providing an important tool when planning optimal treatment approach. This work was supported by FP7ICT-2007-2-5.3 (224297). [1]: pending:yes