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Coronary fractional flow reserve derived from intravascular ultrasound imaging: Validation of a new computational method of fusion between anatomy and physiology.

Artigo em Inglês | MEDLINE | ID: mdl-30277641

OBJECTIVES:

To evaluate the diagnostic performance of a novel computational algorithm based on three-dimensional intravascular ultrasound (IVUS) imaging in estimating fractional flow reserve (IVUS ), compared to gold-standard invasive measurements (FFR ).

BACKGROUND:

IVUS provides accurate anatomical evaluation of the lumen and vessel wall and has been validated as a useful tool to guide percutaneous coronary intervention. However, IVUS poorly represents the functional status (i.e., flow-related information) of the imaged vessel.

METHODS:

Patients with known or suspected stable coronary disease scheduled for elective cardiac catheterization underwent FFR measurement and IVUS imaging in the same procedure to evaluate intermediate lesions. A processing methodology was applied on IVUS to generate a computational mesh condensing the geometric characteristics of the vessel. Computation of IVUS was obtained from patient-level morphological definition of arterial districts and from territory-specific boundary conditions. FFR measurements were dichotomized at the 0.80 threshold to define hemodynamically significant lesions.

RESULTS:

A total of 24 patients with 34 vessels were analyzed. IVUS significantly correlated (r = 0.79; P < 0.001) and showed good agreement with FFR , with a mean difference of -0.008 ± 0.067 (P = 0.47). IVUS presented an overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 91%, 89%, 92%, 80%, and 96%, respectively, to detect significant stenosis.

CONCLUSION:

The computational processing of IVUS is a new method that allows the evaluation of the functional significance of coronary stenosis in an accurate way, enriching the anatomical information of grayscale IVUS.