Noninvasive Assessment of Coronary Artery Disease: Fractional Flow Reserved Derived from Coronary Computed Tomography Angiography (FFRCT)

Mihaela Rațiu; Nora Rat; Sebastian Condrea; Alexandra Stănescu; Diana Opincariu; András Mester; Laura Jani; Imre Benedek; Theodora Benedek

doi:10.1515/jim-2016-0030

.blurhash-client-img { display: none !important; }

Noninvasive Assessment of Coronary Artery Disease: Fractional Flow Reserved Derived from Coronary Computed Tomography Angiography (FFRCT)

Journal of Interdisciplinary Medicine

Volume 1 (2016): Issue 2 (September 2016)

By: Mihaela Rațiu, Nora Rat, Sebastian Condrea, Alexandra Stănescu, Diana Opincariu, András Mester, Laura Jani, Imre Benedek and Theodora Benedek

Open Access

|Oct 2016

Abstract

Invasive coronary angiography (ICA) completed by fractional flow reserve (FFR) assessment represents the main procedure that is performed in the decision process for coronary revascularization. Coronary Computed Tomography Angiography (CCTA) is an effective method used in the noninvasive anatomic assessment of coronary artery disease (CAD). However, CCTA tends to overestimate and does not offer hemodynamic data about the coronary lesions. Recent progresses made in the research involving computational fluid dynamics and image modeling permit the evaluation of FFRCT noninvasively, using data obtained in a standard CCTA. Studies have shown an improved precision and discrimination of FFRCT compared to CCTA for the diagnosis of significant coronary artery stenosis. In this review, we aimed to summarize the role of CCTA in CAD evaluation, the impact of FFRCT, the scientific basis of this novel method and its potential clinical applications.

References

1. Nichols M, Townsend N, Scarborough P, et al. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35:2920-2929.10.1093/eurheartj/ehu299
Search in Google Scholar Back to article
2. Norgaard BL, Leipsic J, Koo BK, et al. Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress. Curr Cardiovasc Rep. 2016;9:2.10.1007/s12410-015-9366-5
Search in Google Scholar Back to article
3. Lucas FL, Siewers AE, Malenka DJ, et al. Diagnostic-therapeutic cascade revisited: coronary angiography, coronary artery bypass graft surgery, and percutaneous coronary intervention in the modern era. Circulation. 2008;118:2797-2802.10.1161/CIRCULATIONAHA.108.789446
Search in Google Scholar Back to article
4. Grunau GL, Min JK, Leipsic J. Modeling of Fractional Flow Reserve Based on Coronary CT Angiography. Curr Cardiol Rep. 2013;15:336.10.1007/s11886-012-0336-0
Search in Google Scholar Back to article
5. Tonino PA, Faeron WF, DeBruyne B, et al. Angiographic versus functional severity of coronary artery stenosis in the FAME study fractional flow reserve versus angiography in multivessel evaluation. J Am Coll Cardiol. 2010;55(25):2816-2821.10.1016/j.jacc.2009.11.096
Search in Google Scholar Back to article
6. Metz LD, Beattie M, Hom R, et al. The prognostic value of normal exercise myocardial perfusion imaging and exercise echocardiography: a meta-analysis. J Am Coll Cardiol. 2007;49:227-237.10.1016/j.jacc.2006.08.048
Search in Google Scholar Back to article
7. Gould KL, Lipscomb K, Hamilton GW. Physiologic basis for assessing critical coronary stenosis. Instantaneous flow response and regional distribution during xoronary hyperemia as measures of coronary flow reserve. Am J Cardiol. 1974;33:87-94.10.1016/0002-9149(74)90743-7
Search in Google Scholar Back to article
8. Uren NG, Melin JA, De Bruyne B, et al. Relation between myocardial blood flow and the severity of coronary-artery stenosis. N Engl J Med. 1994;330(25):1782-1788.10.1056/NEJM1994062333025038190154
Search in Google Scholar Back to article
9. Abd TT, George RT. Association of coronary plaque burden with fractional flow reserve: should we keep attempting to drive physiology from anatomy? Cardiovasc Diagn Ther. 2015;5(1):67-70.
Search in Google Scholar Back to article
10. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the ACCF, AHA, ACP, AATS, PCNA, SCAI, STS. J Am Coll Cardiol. 2012;60(24):44-164.10.1016/j.jacc.2012.07.01323182125
Search in Google Scholar Back to article
11. Pijls NH, Sels JW. Functional Measurment of Coronary Stenosis. J Am Coll Cardiol. 2012;59(12):1045-1057.10.1016/j.jacc.2011.09.07722421298
Search in Google Scholar Back to article
12. Pang CL, Alcock R, Pilkington N, et al. Determining the haemodynamic significance of arterial stenosis: the relationship between CT angiography, computational fluid dynamics, and noninvasive fractional flow reserve. Clin Radiol. 2016;71(8):750-757.10.1016/j.crad.2016.03.00127061041
Search in Google Scholar Back to article
13. Pijls NH, van Son JA, Kirkeeide RL, et al. Experimental basis of determining maximum coronary, myocardial and collateral blood flow by pressure measurements for assessing functional stenosis severity before and after percutaneous transluminal coronary angioplasty. Circulation. 1993;87(4):1354-1367.10.1161/01.CIR.87.4.13548462157
Search in Google Scholar Back to article
14. Pijls NH, van Schaardenburgh, Manoharan G, et al. Percunateous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER study. J Am Coll Cardiol. 2007;49(21):2105-2111.10.1016/j.jacc.2007.01.08717531660
Search in Google Scholar Back to article
15. Boden WE, O’Rouuke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516.10.1056/NEJMoa07082917387127
Search in Google Scholar Back to article
16. Pijls NH, De Bruyene B, Peels K, et al. Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. N Engl J Med. 1996;334(26):1703-1708.10.1056/NEJM1996062733426048637515
Search in Google Scholar Back to article
17. Fearon WF, Bornschein B, Tonino PA, et al. Economic evaluation of fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. Circulation. 2010;122(24):2545-2550.10.1161/CIRCULATIONAHA.109.92539621126973
Search in Google Scholar Back to article
18. Budoff MJ, Shinbane JS. Cardiac CT Imaging: Diagnosis of Cardiovascular Disease – Third Edition. London. Springer-Verlag. 2016.10.1007/978-3-319-28219-0
Search in Google Scholar Back to article
19. Benedek I, Benedek T. Multislice Angio Computed Tomography in the Diagnosis of Cardiovascular Diseases. Oradea. Editura Universitatii din Oradea. 2014
Search in Google Scholar Back to article
20. Benedek I, Chitu M, Kovacs I, et al. Incremental value of preporcedural Coronary Computed Tomographic Angiography to classical Coronary Angiography for prediction of PCI complexity in left main stenosis. World J Cardiovasc Dis. 2013;3(9):537-580.10.4236/wjcd.2013.39090
Search in Google Scholar Back to article
21. Stahli BE, Bonassin F, Goetti R, et al. Coronary Computed Tomography Angiography Indicates Complexity of Percutaneous Coronary Interventions. J Invasive Cardiol. 2012;24(5):196-201.
Search in Google Scholar Back to article
22. Heydari B, Leipsic J, Mancini GB, et al. Diagnostic performance of high-definition coronary computed tomography angiography performed with multiple radiation dose reduction strategies. Can J Cardiol. 2011;27:606-612.10.1016/j.cjca.2010.12.02621963057
Search in Google Scholar Back to article
23. Nakazato R, Otake H, Konishi A, et al. Atherosclerotic plaque characterization by CT angiography for identification of high-risk coronary artery lesions: a comparison to optical coherence tomography. Eur Heart J Cardiovasc Imaging. 2015;16(4):373-379.10.1093/ehjci/jeu18825246503
Search in Google Scholar Back to article
24. Cheruvu C, Naoum C, Blanke P, et al. Beyond Stenosis With Fractional Flow Reserve Via Computed Tomography and Advanced Plaque Analyses for the Diagnosis of Lesion-Specific Ischemia. Can J Cardiol. 2016;28(16):63-65.10.1016/j.cjca.2016.01.02327032888
Search in Google Scholar Back to article
25. Hamon M, Biondi-Zoccai GG, Malagutti P, et al. Diagnostic performance of multislice spiral computed tomography of coronary arteries as compared with conventional invasive coronary angiography: a meta-anatylis. J Am Coll Cardiol. 2006;48:1896-1910.10.1016/j.jacc.2006.08.02817084268
Search in Google Scholar Back to article
26. Kochar M, Min JK. Physiologic assessment of coronary artery disease by cardiac computed tomography. Korean Circ J. 2013;43(7):435-442.10.4070/kcj.2013.43.7.435374473023964289
Search in Google Scholar Back to article
27. Zarins CK, Taylor CA, Min JK. Computed fractional flow reserve (FFRCT) derivated from coronary CT angiography. J Cardiovasc Transl Res. 2013;6(5):708-714.10.1007/s12265-013-9498-4379091623934536
Search in Google Scholar Back to article
28. Taylor CA, Fonte TA, Min JK. Computational Fluid Dynamics Applied to Cardiac Computed Tomography for Noninvasive Quantification of Fractional Flow Reserve. J Am Coll Cardiol. 2013;61(22):2233-2241.10.1016/j.jacc.2012.11.08323562923
Search in Google Scholar Back to article
29. Koo BK, Erglis A, Doh JH, et al. Diagnosis of Ischemia-Causing Coronary Stenoses by Noninvasive Fractional Flow Reserve Computed From Coronary Computed Tomographic Angiograms. Results from the Prospective Multicenter DISCOVER-FLOW Study. J Am Coll Cardiol. 2011;58(19):1989-1997.10.1016/j.jacc.2011.06.06622032711
Search in Google Scholar Back to article
30. Nakazato R, Park HB, Berman DS, et al. Noninvasive fractional flow reserve derived from computed tomography angiography for coronary lesions of intermediate stenosis severity: results from the DeFACTO study. Circ Cardiovasc Imaging. 2013;6(6):881-889.10.1161/CIRCIMAGING.113.00029724081777
Search in Google Scholar Back to article
31. Gaur S, Achenbach S, Leipsic J, et al. Rationale and design of the HeartFlowNXT study. J Cardiovasc Comput Tomogr. 2013;7(5):279-288.10.1016/j.jcct.2013.09.00324268114
Search in Google Scholar Back to article
32. Norgraard BL, Gaur S, Leipsic J, et al. Influence of Coronary Calcification on the Diagnostic Performance of CT Angiography Derived FFR in Coronary Artery Disease: A Substudy of the NXT Trial. Jacc Cardiovasc Imaging. 2015;8(9):1045-1055.10.1016/j.jcmg.2015.06.00326298072
Search in Google Scholar Back to article
33. Hlatky MA, De Bruyne B, Pontone G, et al. Quality-of-Life and Economic Outcomes of Assessing Fractional Flow Reserve With Computed Tomography Angiography: PLATFORM. J Am Coll Cardiol. 2015;66(21):2315-2323.10.1016/j.jacc.2015.09.05126475205
Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.1515/jim-2016-0030 | Journal eISSN: 2501-8132 | Journal ISSN: 2501-5974

Journal RSS Feed

Language: English

Page range: 137 - 141

Submitted on: Sep 7, 2016

Accepted on: Sep 15, 2016

Published on: Oct 24, 2016

Published by: Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

FFRCT,

computational fluid dynamics,

coronary artery disease

Related subjects:

Medicine,

Clinical medicine,

Clinical medicine, other,

Internal medicine,

Internal medicine, other,

Emergency medicine and intensive-care medicine,

Surgery,

Surgery, other

© 2016 Mihaela Rațiu, Nora Rat, Sebastian Condrea, Alexandra Stănescu, Diana Opincariu, András Mester, Laura Jani, Imre Benedek, Theodora Benedek, published by Asociatia Transilvana de Terapie Transvasculara si Transplant KARDIOMED
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Volume 1 (2016): Issue 2 (September 2016)