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. 2021 Oct;98(4):671-677.
doi: 10.1002/ccd.29311. Epub 2020 Oct 6.

Validation of novel 3-dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Kaneshka Masdjedi  1 , Laurens Jc van Zandvoort  1 , Matthew M Balbi  1 , Rutger-Jan Nuis  1 , Jeroen Wilschut  1 , Roberto Diletti  1 , Peter P T de Jaegere  1 , Felix Zijlstra  1 , Nicolas M Van Mieghem  1 , Joost Daemen  1
Affiliations

Validation of novel 3-dimensional quantitative coronary angiography based software to calculate fractional flow reserve post stenting

Kaneshka Masdjedi et al. Catheter Cardiovasc Interv. 2021 Oct.

Abstract

Objectives: To validate novel dedicated 3D-QCA based on the software to calculate post PCI vessel-FFR (vFFR) in a consecutive series of patients, to assess the diagnostic accuracy, and to assess inter-observer variability.

Background: Low post percutaneous coronary intervention (PCI) fractional flow reserve (FFR) predicts future adverse cardiac events. However, FFR assessment requires the insertion of a pressure wire in combination with the use of a hyperemic agent.

Methods: FAST POST study is an observational, retrospective, single-center cohort study. One hundred patients presenting with stable angina or non ST-elevation myocardial infarction, who underwent post PCI FFR assessment using a dedicated microcatheter were included. Two orthogonal angiographic projections were acquired to create a 3D reconstruction of the coronary artery using the CAAS workstation 8.0. vFFR was subsequently calculated using the aortic root pressure.

Results: Mean age was 65±12 years and 70% were male. Mean microcatheter based FFR and vFFR were 0.91±0.07 and 0.91±0.06, respectively. A good linear correlation was found between FFR and vFFR (r = 0.88; p <.001). vFFR had a higher accuracy in the identification of patients with FFR values <0.90, AUC 0.98 (95% CI: 0.96-1.00) as compared with 3D-QCA AUC 0.62 (95% CI: 0.94-0.74). Assessment of vFFR had a low inter-observer variability (r = 0.95; p <.001).

Conclusion: 3D-QCA derived post PCI vFFR correlates well with invasively measured microcatheter based FFR and has a high diagnostic accuracy to detect FFR <0.90 with low inter-observer variability.

Keywords: coronary angiography; fractional flow reserve; quantitative coronary angiography.

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Figures

FIGURE 1
FIGURE 1
Flowchart of all included and excluded patients
FIGURE 2
FIGURE 2
Scatter plot showing the relationship between vessel‐FFR (vFFR) and invasive measured FFR using a rapid exchange microcatheter (FFR) (a) and Bland–Altman plots of differences against the means (b). The mean bias is represented by the solid red line and the 95% confidence interval is represented by the dashed lines. FFR, fractional flow reserve; vFFR, vessel fractional flow reserve [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Scatter plot (a) and Bland–Altman analysis of inter‐observer variability (b). The mean bias is represented by the solid red line and the 95% confidence interval is represented by the dashed lines [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
ROC curves for vFFR and 3D‐QCA. Comparison is made with an FFR at a cut point of 0.89 as shown in Table 1. 3D‐QCA, three dimensional quantitative coronary angiography; vFFR, vessel fractional flow reserve [Color figure can be viewed at wileyonlinelibrary.com]
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