Sadeghian Mohammad, Mohammadi Vahid, Shafiee Akbar, Babakhani Hamidreza
MD, Department of Cardiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
MD, Department of Cardiovascular Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
J Biomed Phys Eng. 2021 Dec 1;11(6):685-692. doi: 10.31661/jbpe.v0i0.1160. eCollection 2021 Dec.
Fractional flow reserve (FFR) is a gold standard to assess the impact of stenosis on the blood flow. The FFR method enhances diagnostic accuracy, lessens the need for stenting, and reduces costs. However, FFR is used in less than 10% of percutaneous coronary intervention (PCI) procedures because it needs pressure wires to measure the distal and proximal pressures and adenosine to create hyperemic conditions. Pressure-wire-based FFR measurement is, therefore, expensive and invasive.
This study aims to introduce a new approach on the basis of 3D coronary angiography and the Thrombolysis in Myocardial Infarction (TIMI) frame count for fast computation of FFR in patients with coronary artery disease.
In this simulation study, we herein introduce Non-Invasive Flow Ratio drawing upon CFD to measure FFR based on coronary angiography images with less run time. In this study, 3D geometry was created based on coronary angiography images. The mean volumetric flow rate was calculated using the TIMI frame count. FFR calculated based on CFD was compared with pressure-wire-based FFR and NiFR was calculated in 85 patients.
The NiFR (r = 0.738, P< 0.001) exhibited a strong correlation with pressure-wire-based FFR. The result indicated that FFR was higher than 0.8 in the arteries with non-signif-icant stenosis and lower than 0.8 in the arter-ies with significant stenosis.
The computational simulation of FFR and hemodynamic parameters such as pressure drop is a safe, efficient, and cost-effective method to evaluate the severity of coronary stenosis.
血流储备分数（FFR）是评估狭窄对血流影响的金标准。FFR方法提高了诊断准确性，减少了支架置入的需求，并降低了成本。然而，FFR在不到10%的经皮冠状动脉介入治疗（PCI）手术中使用，因为它需要压力导丝来测量远端和近端压力，以及腺苷来创造充血状态。因此，基于压力导丝的FFR测量既昂贵又具有侵入性。
本研究旨在基于三维冠状动脉造影和心肌梗死溶栓（TIMI）帧数引入一种新方法，用于快速计算冠心病患者的FFR。
在本模拟研究中，我们引入基于计算流体动力学（CFD）的无创血流比（NiFR），以基于冠状动脉造影图像在更短运行时间内测量FFR。在本研究中，基于冠状动脉造影图像创建三维几何结构。使用TIMI帧数计算平均体积流率。将基于CFD计算的FFR与基于压力导丝的FFR进行比较，并在85例患者中计算NiFR。
NiFR（r = 0.738，P < 0.001）与基于压力导丝的FFR表现出强相关性。结果表明，在无显著狭窄的动脉中FFR高于0.8，在有显著狭窄的动脉中FFR低于0.8。
FFR及诸如压力降等血流动力学参数的计算模拟是评估冠状动脉狭窄严重程度的一种安全、高效且具有成本效益的方法。
