Quantification of fractional flow reserve based on angiographic image data

Coronary angiography provides excellent visualization of coronary arteries, but has limitations in assessing the clinical significance of a coronary stenosis. Fractional flow reserve (FFR) has been shown to be reliable in discerning stenoses responsible for inducible ischemia. The purpose of this study is to validate a technique for FFR quantification using angiographic image data. The study was carried out on 10 anesthetized, closed-chest swine using angioplasty balloon catheters to produce partial occlusion. Angiography based FFR was calculated from an angiographically measured ratio of coronary blood flow to arterial lumen volume. Pressure-based FFR was measured from a ratio of distal coronary pressure to aortic pressure. Pressure-wire measurements of FFR (FFRP) correlated linearly with angiographic volume-derived measurements of FFR (FFRV) according to the equation: FFRP = 0.41 FFRV + 0.52 (P-value < 0.001). The correlation coefficient and standard error of estimate were 0.85 and 0.07, respectively. This is the first study to provide an angiographic method to quantify FFR in swine. Angiographic FFR can potentially provide an assessment of the physiological severity of a coronary stenosis during routine diagnostic cardiac catheterization without a need to cross a stenosis with a pressure-wire.

[1]  M. Winniford,et al.  Effect of increases in heart rate and arterial pressure on coronary flow reserve in humans. , 1993, Journal of the American College of Cardiology.

[2]  C. White,et al.  Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? , 1984, The New England journal of medicine.

[3]  T van der Werf,et al.  Mean transit time for the assessment of myocardial perfusion by videodensitometry. , 1990, Circulation.

[4]  Olv Clinic.  Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease , 2005 .

[5]  James H. Brown,et al.  A General Model for the Origin of Allometric Scaling Laws in Biology , 1997, Science.

[6]  J. Yap,et al.  Assessment of the reproducibility of baseline and hyperemic myocardial blood flow measurements with 15O-labeled water and PET. , 1999, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[7]  Greg Bednarz,et al.  Absolute volumetric coronary blood flow measurement with digital subtraction angiography , 1998, The International Journal of Cardiac Imaging.

[8]  William Wijns,et al.  Long-term clinical outcome after fractional flow reserve-guided percutaneous coronary intervention in patients with multivessel disease. , 2005, Journal of the American College of Cardiology.

[9]  F. Hanley,et al.  Effects of Pressure Gradients between Branches of the Left Coronary Artery on the Pressure Axis Intercept and the Shape of Steady State Circumflex Pressure‐Flow Relations in Dogs , 1985, Circulation research.

[10]  J. Murray,et al.  Variability in the Analysis of Coronary Arteriograms , 1977, Circulation.

[11]  Sabee Molloi,et al.  Regional volumetric coronary blood flow measurement by digital angiography: in vivo validation. , 2004, Academic radiology.

[12]  P. Hartigan,et al.  Relation between coronary artery stenosis assessed by visual, caliper, and computer methods and exercise capacity in patients with single-vessel coronary artery disease. The Veterans Affairs ACME Investigators. , 1994, Circulation.

[13]  R. Dinsmore,et al.  Interobserver Variability in Coronary Angiography , 1976, Circulation.

[14]  T. Takaro,et al.  Observer Agreement in Evaluating Coronary Angiograms , 1975, Circulation.

[15]  A Bol,et al.  Coronary flow reserve calculated from pressure measurements in humans. Validation with positron emission tomography. , 1994, Circulation.

[16]  W Wijns,et al.  Fractional Flow Reserve to Determine the Appropriateness of Angioplasty in Moderate Coronary Stenosis: A Randomized Trial , 2001, Circulation.

[17]  Pulsatile coronary flow determination by digital angiography , 2005, The International Journal of Cardiac Imaging.

[18]  G. Kassab.  Scaling laws of vascular trees: of form and function. , 2006, American journal of physiology. Heart and circulatory physiology.

[19]  Jerry T. Wong,et al.  Determination of fractional flow reserve (FFR) based on scaling laws: a simulation study , 2008, Physics in medicine and biology.

[20]  J Hicks,et al.  Quantification of volumetric coronary blood flow with dual-energy digital subtraction angiography. , 1996, Circulation.

[21]  Maria Siebes,et al.  Physiological Basis of Clinically Used Coronary Hemodynamic Indices , 2006, Circulation.

[22]  C A Mistretta,et al.  Quantification techniques for dual-energy cardiac imaging. , 1989, Medical physics.

[23]  A. Sinha Roy,et al.  Functional and anatomical diagnosis of coronary artery stenoses. , 2008, The Journal of surgical research.

[24]  J. Bristow,et al.  Low zero-flow pressure and minimal capacitance effect on diastolic coronary arterial pressure-flow relationships during maximum vasodilation in swine. , 1984, Circulation.

[25]  O. Rimoldi,et al.  Heterogeneity of resting and hyperemic myocardial blood flow in healthy humans. , 2001, Cardiovascular research.

[26]  Ghassan S Kassab,et al.  Scaling of myocardial mass to flow and morphometry of coronary arteries. , 2008, Journal of applied physiology.

[27]  W. Wijns,et al.  Long-term follow-up after deferral of percutaneous transluminal coronary angioplasty of intermediate stenosis on the basis of coronary pressure measurement. , 1998, Journal of the American College of Cardiology.

[28]  M. Leesar,et al.  Thirty-month outcome after fractional flow reserve-guided versus conventional multivessel percutaneous coronary intervention. , 2005, The American journal of cardiology.

[29]  R. Boellaard,et al.  Microvascular Function in Viable Myocardium After Chronic Infarction Does Not Influence Fractional Flow Reserve Measurements , 2007, Journal of Nuclear Medicine.

[30]  W. Wijns,et al.  Simultaneous coronary pressure and flow velocity measurements in humans. Feasibility, reproducibility, and hemodynamic dependence of coronary flow velocity reserve, hyperemic flow versus pressure slope index, and fractional flow reserve. , 1996, Circulation.

[31]  Ghassan S. Kassab,et al.  Quantification of Coronary Artery Lumen Volume by Digital Angiography: In Vivo Validation , 2001, Circulation.

[32]  Jerry T. Wong,et al.  Quantitative coronary angiography using image recovery techniques for background estimation in unsubtracted images. , 2007, Medical physics.

[33]  G. Kassab,et al.  Effect of compliance and hematocrit on wall shear stress in a model of the entire coronary arterial tree. , 2009, Journal of applied physiology.

[34]  R. Wilson,et al.  Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure, and ventricular preload. , 1990, Circulation.

[35]  M. Kern,et al.  Coronary pathophysiology in the cardiac catheterization laboratory. , 2006, Current problems in cardiology.

[36]  Yao-Jin Qian,et al.  A digital filtration technique for scatter-glare correction based on thickness estimation , 1995, IEEE Trans. Medical Imaging.

[37]  B. De Bruyne,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 , 1993, Circulation.

[38]  P. H. van der Voort,et al.  Measurement of fractional flow reserve to assess the functional severity of coronary-artery stenoses. , 1996, The New England journal of medicine.

[39]  G. Mancini,et al.  Tachycardia, contractility and volume loading alter conventional indexes of coronary flow reserve, but not the instantaneous hyperemic flow versus pressure slope index. , 1992, Journal of the American College of Cardiology.

[40]  Sabee Molloi,et al.  Regional blood flow analysis and its relationship with arterial branch lengths and lumen volume in the coronary arterial tree , 2007, Physics in medicine and biology.

[41]  R. Mates,et al.  Zero-flow pressures and pressure-flow relationships during single long diastoles in the canine coronary bed before and during maximum vasodilation. Limited influence of capacitive effects. , 1981, The Journal of clinical investigation.