Non‐invasive procedural planning using computed tomography‐derived fractional flow reserve

• Published in: Catheterization and cardiovascular interventions Vol. 97; no. 4; pp. 614 - 622
• Main Authors: Bom, Michiel J., Schumacher, Stefan P., Driessen, Roel S., Diemen, Pepijn A., Everaars, Henk, Winter, Ruben W., Ven, Peter M., Rossum, Albert C., Sprengers, Ralf W., Verouden, Niels J.W., Nap, Alexander, Opolski, Maksymilian P., Leipsic, Jonathon A., Danad, Ibrahim, Taylor, Charles A., Knaapen, Paul
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.03.2021; Wiley Subscription Services, Inc
• Subjects: Angiography; Computed tomography; computed tomography derived fractional flow reserve; Coronary Artery Disease; coronary computed tomography angiography; fractional flow reserve; Medical imaging; Original Studies; percutaneous coronary intervention; coronary artery disease; percutaneous coronary intervention; coronary computed tomography angiography; computed tomography derived fractional flow reserve; fractional flow reserve
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.29210

Objectives This study aimed to investigate the performance of computed tomography derived fractional flow reserve based interactive planner (FFRCT planner) to predict the physiological benefits of percutaneous coronary intervention (PCI) as defined by invasive post‐PCI FFR. Background Advances in FFRCT technology have enabled the simulation of hyperemic pressure changes after virtual removal of stenoses. Methods In 56 patients (63 vessels) invasive FFR measurements before and after PCI were obtained and FFRCT was calculated using pre‐PCI coronary CT angiography. Subsequently, FFRCT and invasive coronary angiography models were aligned allowing virtual removal of coronary stenoses on pre‐PCI FFRCT models in the same locations as PCI was performed. Relationships between invasive FFR and FFRCT, between post‐PCI FFR and FFRCT planner, and between delta FFR and delta FFRCT were evaluated. Results Pre PCI, invasive FFR was 0.65 ± 0.12 and FFRCT was 0.64 ± 0.13 (p = .34) with a mean difference of 0.015 (95% CI: −0.23–0.26). Post‐PCI invasive FFR was 0.89 ± 0.07 and FFRCT planner was 0.85 ± 0.07 (p < .001) with a mean difference of 0.040 (95% CI: −0.10–0.18). Delta invasive FFR and delta FFRCT were 0.23 ± 0.12 and 0.21 ± 0.12 (p = .09) with a mean difference of 0.025 (95% CI: −0.20–0.25). Significant correlations were found between pre‐PCI FFR and FFRCT (r = 0.53, p < .001), between post‐PCI FFR and FFRCT planner (r = 0.41, p = .001), and between delta FFR and delta FFRCT (r = 0.57, p < .001). Conclusions The non‐invasive FFRCT planner tool demonstrated significant albeit modest agreement with post‐PCI FFR and change in FFR values after PCI. The FFRCT planner tool may hold promise for PCI procedural planning; however, improvement in technology is warranted before clinical application.