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Virtual Coronary Intervention: A Treatment Planning Tool Based Upon the Angiogram.

ABSTRACT: OBJECTIVES:This study sought to assess the ability of a novel virtual coronary intervention (VCI) tool based on invasive angiography to predict the patient's physiological response to stenting. BACKGROUND:Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with improved clinical and economic outcomes compared with angiographic guidance alone. Virtual (v)FFR can be calculated based upon a 3-dimensional (3D) reconstruction of the coronary anatomy from the angiogram, using computational fluid dynamics (CFD) modeling. This technology can be used to perform virtual stenting, with a predicted post-PCI FFR, and the prospect of optimized treatment planning. METHODS:Patients undergoing elective PCI had pressure-wire-based FFR measurements pre- and post-PCI. A 3D reconstruction of the diseased artery was generated from the angiogram and imported into the VIRTUheart workflow, without the need for any invasive physiological measurements. VCI was performed using a radius correction tool replicating the dimensions of the stent deployed during PCI. Virtual FFR (vFFR) was calculated pre- and post-VCI, using CFD analysis. vFFR pre- and post-VCI were compared with measured (m)FFR pre- and post-PCI, respectively. RESULTS:Fifty-four patients and 59 vessels underwent PCI. The mFFR and vFFR pre-PCI were 0.66 ± 0.14 and 0.68 ± 0.13, respectively. Pre-PCI vFFR deviated from mFFR by ±0.05 (mean ? = -0.02; SD = 0.07). The mean mFFR and vFFR post-PCI/VCI were 0.90 ± 0.05 and 0.92 ± 0.05, respectively. Post-VCI vFFR deviated from post-PCI mFFR by ±0.02 (mean ? = -0.01; SD = 0.03). Mean CFD processing time was 95 s per case. CONCLUSIONS:The authors have developed a novel VCI tool, based upon the angiogram, that predicts the physiological response to stenting with a high degree of accuracy.

SUBMITTER: Gosling RC

PROVIDER: S-EPMC6503181 | biostudies-literature | 2019 May

REPOSITORIES: biostudies-literature

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Virtual Coronary Intervention: A Treatment Planning Tool Based Upon the Angiogram.

Gosling Rebecca C RC Morris Paul D PD Silva Soto Daniel A DA Lawford Patricia V PV Hose D Rodney DR Gunn Julian P JP

JACC. Cardiovascular imaging 20180314 5

<h4>Objectives</h4>This study sought to assess the ability of a novel virtual coronary intervention (VCI) tool based on invasive angiography to predict the patient's physiological response to stenting.<h4>Background</h4>Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) is associated with improved clinical and economic outcomes compared with angiographic guidance alone. Virtual (v)FFR can be calculated based upon a 3-dimensional (3D) reconstruction of the coronary anat ...[more]

PMID: 29550308

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Dataset Information

Virtual Coronary Intervention: A Treatment Planning Tool Based Upon the Angiogram.

Publications

Virtual Coronary Intervention: A Treatment Planning Tool Based Upon the Angiogram.

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