Non‐invasive procedural planning using computed tomography‐derived fractional flow reserve
Michiel J. Bom, Stefan Schumacher, Roel S. Driessen, Pepijn A. van Diemen, Henk Everaars, Ruben W. de Winter, Peter M. van de Ven, Albert C. van Rossum, Ralf W. Sprengers, Niels Verouden, Alexander Nap, Maksymilian P. Opolski, Jonathon Leipsic, Ibrahim Danad, Charles A. Taylor, Paul Knaapen
Abstract
Abstract Objectives This study aimed to investigate the performance of computed tomography derived fractional flow reserve based interactive planner (FFR CT planner) to predict the physiological benefits of percutaneous coronary intervention (PCI) as defined by invasive post‐PCI FFR. Background Advances in FFR CT technology have enabled the simulation of hyperemic pressure changes after virtual removal of stenoses. Methods In 56 patients (63 vessels) invasive FFR measurements before and after PCI were obtained and FFR CT was calculated using pre‐PCI coronary CT angiography. Subsequently, FFR CT and invasive coronary angiography models were aligned allowing virtual removal of coronary stenoses on pre‐PCI FFR CT models in the same locations as PCI was performed. Relationships between invasive FFR and FFR CT , between post‐PCI FFR and FFR CT planner, and between delta FFR and delta FFR CT were evaluated. Results Pre PCI, invasive FFR was 0.65 ± 0.12 and FFR CT was 0.64 ± 0.13 ( p = .34) with a mean difference of 0.015 (95% CI: −0.23–0.26). Post‐PCI invasive FFR was 0.89 ± 0.07 and FFR CT planner was 0.85 ± 0.07 ( p < .001) with a mean difference of 0.040 (95% CI: −0.10–0.18). Delta invasive FFR and delta FFR CT were 0.23 ± 0.12 and 0.21 ± 0.12 ( p = .09) with a mean difference of 0.025 (95% CI: −0.20–0.25). Significant correlations were found between pre‐PCI FFR and FFR CT (r = 0.53, p < .001), between post‐PCI FFR and FFR CT planner (r = 0.41, p = .001), and between delta FFR and delta FFR CT (r = 0.57, p < .001). Conclusions The non‐invasive FFR CT planner tool demonstrated significant albeit modest agreement with post‐PCI FFR and change in FFR values after PCI. The FFR CT planner tool may hold promise for PCI procedural planning; however, improvement in technology is warranted before clinical application.