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. 2013;9(2):160-9.
doi: 10.5114/pwki.2013.35452. Epub 2013 Jun 17.

Invasive and non-invasive fractional flow reserve index in validation of hemodynamic severity of intracoronary lesions

Jarosław Wasilewski  1 , Kryspin Mirota  2 , Michał Hawranek  1 , Lech Poloński  1
Affiliations

Invasive and non-invasive fractional flow reserve index in validation of hemodynamic severity of intracoronary lesions

Jarosław Wasilewski et al. Postepy Kardiol Interwencyjnej. 2013.

Abstract

This review discusses visual and functional evaluation of the hemodynamic significance of the degree of stenosis in coronary angiography, with respect to the indications for revascularization. The concept of the coronary flow reserve is defined, and the theoretical assumptions of the invasive measurement of the fractional flow reserve (FFR) are presented. In the following part, the publication describes the basic steps of numerical stimulations in terms of computational fluid dynamics (CFD) in calculating the fractional flow reserve based on computed tomography (CT) coronary angiography (FFRCT). The numerical FFRCT estimation in correlation with invasive measurements, as well as benefits deriving from FFRCT in the diagnosis of coronary artery disease, is presented in the example of the multicentre prospective DISCOVER-FLOW trial and the DeFACTO project. The CDF method enables to obtain hemodynamic significance of stenosis solely from the coronary anatomy vizualized by CT angiography. The calculation of FFRCT increases the diagnostic reliability of coronary flow reserve estimations. It contributes to the improvement in patients' qualification for contrast coronarography. If the accuracy of FFRCT is confirmed in clinical practice, and the time required for computational processing is shortened, it may turn out that the algorithms of coronary heart disease diagnosis will be verified and it will be to a greater extent based on the CT results.

Keywords: computational fluid dynamics; fractional flow reserve.

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Figures

Fig. 1
Fig. 1
Definitional scheme of fractional flow reserve related to the pressure
Fig. 2
Fig. 2
Schematic realization of the computational flow problem by means of CFD
Fig. 3
Fig. 3
Reconstruction of the central line and a final computational grid based on over 2 million finite elements
Fig. 4
Fig. 4
FFRCT result based on coronary angio-CT images obtained by means of computational methods. For the circumflex artery the measured FFRCT is lower than 0.8. It may be assumed that this stenosis is hemodynamically significant
See this image and copyright information in PMC

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