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. 2019 Jun 20;15(2):189-197.
doi: 10.4244/EIJ-D-19-00182.

Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity

Wei Yu  1 , Jiayue Huang, Dean Jia, Shaoliang Chen, Owen Christopher Raffel, Daixin Ding, Feng Tian, Jing Kan, Su Zhang, Fuhua Yan, Yundai Chen, Hiram G Bezerra, William Wijns, Shengxian Tu
Affiliations

Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity

Wei Yu et al. EuroIntervention. .

Abstract

Aims: A novel method for computation of fractional flow reserve (FFR) from optical coherence tomography (OCT) was developed recently. This study aimed to evaluate the diagnostic accuracy of a new OCT-based FFR (OFR) computational approach, using wire-based FFR as the reference standard.

Methods and results: Patients who underwent both OCT and FFR prior to intervention were analysed. The lumen of the interrogated vessel and the ostia of the side branches were automatically delineated and used to compute OFR. Bifurcation fractal laws were applied to correct the change in reference lumen size due to the step-down phenomenon. OFR was compared with FFR, both using a cut-off value of 0.80 to define ischaemia. Computational analysis was performed in 125 vessels from 118 patients. Average FFR was 0.80±0.09. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for OFR to identify FFR ≤0.80 was 90% (95% CI: 84-95), 87% (95% CI: 77-94), 92% (95% CI: 82-97), 92% (95% CI: 82-97), and 88% (95% CI: 77-95), respectively. The AUC was higher for OFR than minimal lumen area (0.93 [95% CI: 0.87-0.97] versus 0.80 [95% CI: 0.72-0.86], p=0.002). Average OFR analysis time was 55±23 seconds for each OCT pullback. Intra- and inter-observer variability in OFR analysis was 0.00±0.02 and 0.00±0.03, respectively.

Conclusions: OFR is a novel and fast method allowing assessment of flow-limiting coronary stenosis without pressure wire and induced hyperaemia. The good diagnostic accuracy and low observer variability bear the potential of improved integration of intracoronary imaging and physiological assessment.

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Figures

Figure 1.
Figure 1.
Study flow chart.
Figure 2.
Figure 2.
Histogram distribution of FFR and OFR. A) Histogram distribution of FFR. B) Histogram distribution of OFR.
Figure 3.
Figure 3.
Computation of OFR by OCT on a LAD with physiologically non-significant stenosis. A) Coronary angiography shows a LAD lesion; MLA by OCT is 1.81 mm². FFR measured by pressure wire at asterisk was 0.84. Four white triangles point to the positions of four side branches, which correspond with b1–b4 in panel B and in panel C. B) The four white lines in the OCT longitudinal views show the angulations of the cut-planes (b1–b4) perpendicular to the side branch centreline. The cut-planes were automatically reconstructed and the lumen of the side branch ostia in the cut-planes was automatically delineated. C) The computed OFR value was colour-coded and superimposed on the 3D reconstructed artery. In this case, the computed OFR was 0.84, exactly the same as FFR. FFR: fractional flow reserve; LAD: left anterior descending artery; MLA: minimal lumen area; OCT: optical coherence tomography; OFR: OCT-based FFR
Figure 4.
Figure 4.
Computation of OFR by OCT on a LAD with physiologically significant stenosis. A) Coronary angiography shows a LAD lesion; MLA by OCT is 2.11 mm². FFR measured by pressure wire at asterisk was 0.80. Four white triangles point to the positions of four side branches, which correspond with b1–b4 in panel B and in panel C. B) The four white lines in the OCT longitudinal views show the angulations of the cut-planes (b1–b4) perpendicular to the side branch centreline. The cut-planes were automatically reconstructed and the lumen of the side branch ostia in the cut-planes was automatically delineated. C) The computed OFR value was colour-coded and superimposed on the 3D reconstructed artery. In this case, the computed OFR was 0.78. FFR: fractional flow reserve; LAD: left anterior descending artery; MLA: minimal lumen area; OCT: optical coherence tomography; OFR: OCT-based FFR
Figure 5.
Figure 5.
Correlation and agreement between FFR and OFR. A) Good correlation (r=0.70) between FFR and OFR was observed. B) Bland-Altman plot shows good agreement between FFR and OFR. FFR: fractional flow reserve; LAD: left anterior descending artery; MLA: minimal lumen area; OCT: optical coherence tomography; OFR: OCT-based FFR; SD: standard deviation
Figure 6.
Figure 6.
ROC curves for diagnosis of physiologically significant stenoses. OFR shows significantly higher diagnostic accuracy than OCT-derived MLA in identifying flow-limiting coronary stenosis defined by FFR ≤0.80. AUC: area under the curve; FFR: fractional flow reserve; LAD: left anterior descending artery; MLA: minimal lumen area; OCT: optical coherence tomography; OFR: OCT-based FFR; ROC: receiver-operating characteristic
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References

    1. Tonino PA, De Bruyne B, Pijls NHJ, Siebert U, Ikeno F, van `t Veer M, Klauss V, Manoharan G, Engstrøm T, Oldroyd KG, Ver Lee PN, MacCarthy PA, Fearon WF; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24. - PubMed
    1. Xaplanteris P, Fournier S, Pijls NHJ, Fearon WF, Barbato E, Tonino PAL, Engstrøm T, Kääb S, Dambrink JH, Rioufol G, Toth GG, Piroth Z, Witt N, Fröbert O, Kala P, Linke A, Jagic N, Mates M, Mavromatis K, Samady H, Irimpen A, Oldroyd K, Campo G, Rothenbühler M, Jüni P, De Bruyne B; FAME 2 Investigators. Five-Year Outcomes with PCI Guided by Fractional Flow Reserve. N Engl J Med. 2018;379:250–9. - PubMed
    1. Götberg M, Cook CM, Sen S, Nijjer S, Escaned J, Davies JE. The Evolving Future of Instantaneous Wave-Free Ratio and Fractional Flow Reserve. J Am Coll Cardiol. 2017;70:1379–402. - PubMed
    1. Tu S, Westra J, Yang J, von Birgelen C, Ferrara A, Pellicano M, Nef H, Tebaldi M, Murasato Y, Lansky A, Barbato E, van der Heijden LC, Reiber JHC, Holm NR, Wijns W; FAVOR Pilot Trial Study Group. Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv. 2016;9:2024–35. - PubMed
    1. Xu B, Tu S, Qiao S, Qu X, Chen Y, Yang J, Guo L, Sun Z, Li Z, Tian F, Fang W, Chen J, Li W, Guan C, Holm NR, Wijns W, Hu S. Diagnostic Accuracy of Angiography-Based Quantitative Flow Ratio Measurements for Online Assessment of Coronary Stenosis. J Am Coll Cardiol. 2017;70:3077–87. - PubMed