Coronary Plaque Morphology with Reduced Order CFD Based Fractional Flow Reserve for Lesion-Specific Ischemia Assessment

Abstract

Coronary artery fractional flow reserve (FFR), the ratio of distal to proximal pressures in a stenotic lesion, has been shown to confer clear benefit for guiding percutaneous coronary intervention (PCI). However, FFR requires pressure to be measured invasively, which is a barrier to wider use of the method. A noninvasive method to quantify FFR is needed. We described methods which can be used to characterize the coronary plaque morphology and to derive FFR from computed tomography coronary angiography (CTCA) with reduced-order computational fluid dynamic (CFD) algorithm. We studied the diagnostic performance of the method for diagnosing ischemic lesion with reference to the gold standard of invasive FFR in human subjects. 49 patients with 61 lesions were analyzed. The results demonstrated better accuracy than anatomical assessment. Coronary plaque morphology with reduced order computational fluid dynamics-based FFR improved diagnostic accuracy and can reduce the risks associated with invasive coronary angiography.