Diagnostic performance of a vessel-length-based method to compute the instantaneous wave-free ratio in coronary arteries

Sci Rep. 2020 Jan 24;10(1):1132. doi: 10.1038/s41598-020-57424-w.

Abstract

The instantaneous wave-free ratio (iFR) is a recently introduced vasodilator-free index to assess the functional severity of coronary stenosis in the resting state, while fractional flow reserve (FFR) is the gold standard index in hyperemia. The computed instantaneous wave-free ratio (CT-iFR) is a noninvasive method to estimate iFR using computer simulations. Here, we developed a vessel-length-based CT-iFR method in patient-specific models of coronary arteries. This method was implemented by coupling a three-dimensional computational fluid dynamics model with a lumped parameter model (LPM) of coronary circulation in a non-hyperemic resting state. A time-varying resistance in the LPM was used for the iFR simulation. In total, 50 coronary vessels of 32 patients were computed, and their CT-iFR values were compared with clinically measured iFRs to evaluate the diagnostic performance of the present CT-iFR method. The area under the receiver operating characteristics curve of CT-iFR validation was 0.93. In diagnostic performances of CT-iFR, accuracy, sensitivity, and specificity were 86%, 83.3%, and 86.8%, respectively. These results indicate that this CT-iFR method can be used as a pre-operative aid to establish a percutaneous coronary intervention strategy as a noninvasive alternative to iFR.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Area Under Curve
  • Computed Tomography Angiography
  • Computer Simulation
  • Coronary Stenosis / diagnosis*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / physiopathology
  • Coronary Stenosis / surgery
  • Female
  • Hemodynamics
  • Humans
  • Hydrodynamics
  • Imaging, Three-Dimensional
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention
  • Preoperative Care
  • ROC Curve
  • Rest
  • Sensitivity and Specificity
  • Vascular Calcification / diagnostic imaging