4 years ago

Comparison of Accuracy of One Use Methods for Calculating Fractional Flow Reserve by Intravascular Optical Coherence Tomography to That Determined by the Pressure-Wire Method

While identification of hemodynamic significance of coronary lesions becomes important for revascularization strategy, the potential role of three-dimensional high-resolution intracoronary Optical coherence tomography (OCT) for predicting functional significance of coronary lesions remains unclear. We assessed the diagnostic performance of two computational approaches for deriving fractional flow reserve (FFR) from intravascular OCT images. We developed two methods to derive FFR from volumetric OCT images by applying analytical fluid dynamics (FFR-OCTAFD) and computational fluid dynamics (FFR-OCTCFD). Among 217 eligible patients between 2011 and 2014, total 104 patients were included for data analysis (9 for derivation, 95 for validation). Luminal geometries from three-dimensional OCT were used for both FFR-OCTAFD and FFR-OCTCFD calculations. The AFD method calculated FFR from the blood flow resistance estimated using Poiseuille's law. For CFD, we numerically solved the Navier-Stokes equation in a steady-state flow with the distal porous media model for the capillary vessels. We examined diagnostic performance of FFR-OCTAFD and FFR-OCTCFD compared with the pressure-wire measured FFR. The accuracy, sensitivity, specificity, PPV, and NPV were 86%, 65%, 94%, 81%, and 88% for FFR-OCTAFD, and 86%, 73%, 91%, 76%, and 90% for FFR-OCTCFD. The area under curve (AUC) of receiver-operating characteristic curve was 0.88 for FFR-OCTAFD and 0.86 for FFR-OCTCFD. FFR-OCTAFD and FFR-OCTCFD showed strong linear correlation with the measured FFR (r=0.631; p<0.001, r=0.655; p<0.001, respectively). FFR derived from high-resolution volumetric OCT images showed high diagnostic performance for the detection of coronary ischemia. In conclusion, FFR-OCT may be useful for guiding the management of coronary artery disease.

Publisher URL: www.sciencedirect.com/science

DOI: S0002914917313802

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