Optimal Application of Fractional Flow Reserve to Assess Serial Coronary Artery Disease: A 3D-Printed Experimental Study With Clinical Validation.
Background Assessing the physiological significance of stenoses with coexistent serial disease is prone to error. We aimed to use 3-dimensional-printing to characterize serial stenosis interplay and to derive and validate a mathematical solution to predict true stenosis significance in serial diseas...
| Published in: | Journal of the American Heart Association Vol. 7; no. 20; pp. 1 - 15 |
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| Main Authors: | , , , , , , , , , |
| Format: | research Journal Article |
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Wiley-Blackwell
10/16/2018
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133058002&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 133058002 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20479980 FSQ9 jtl: Journal of the American Heart Association issn: 20479980 maglogo: Y pubinfo: dt: 10/16/2018 vid: 7 iid: 20 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 133058002 133058002 NLM30371265 133058002 10.1161/JAHA.118.010279 NLM30371265 133058002 ppf: 1 ppct: 14 formats: tig: atl: Optimal Application of Fractional Flow Reserve to Assess Serial Coronary Artery Disease: A 3D-Printed Experimental Study With Clinical Validation. aug: au: Modi, Bhavik N. Ryan, Matthew Chattersingh, Anjalee Eruslanova, Kseniia Ellis, Howard Gaddum, Nicholas Lee, Jack Clapp, Brian Chowienczyk, Phil Perera, Divaka affil: NIHR Biomedical Research Centre and British Heart Foundation Centre of Excellence, School of Cardiovascular Medicine and Sciences, St Thomas' Campus, King's College London, London, United Kingdom sug: subj: Printing, Three-Dimensional Coronary Circulation Physiology Coronary Stenosis Cardiovascular Care Coronary Stenosis Surgery Models, Biological Female Coronary Stenosis Physiopathology Phantoms, Imaging Human Middle Age Male Angina, Stable Physiopathology Angina, Stable Validation Studies Comparative Studies Evaluation Research Multicenter Studies Scales Middle Aged: 45-64 years Female Male ab: Background Assessing the physiological significance of stenoses with coexistent serial disease is prone to error. We aimed to use 3-dimensional-printing to characterize serial stenosis interplay and to derive and validate a mathematical solution to predict true stenosis significance in serial disease. Methods and Results Fifty-two 3-dimensional-printed serial disease phantoms were physiologically assessed by pressure-wire pullback (Δ FFR app) and compared with phantoms with the stenosis in isolation (Δ FFR true). Mathematical models to minimize error in predicting FFR true, the FFR in the vessel where the stenosis is present in isolation, were subsequently developed using 32 phantoms and validated in another 20 and also a clinical cohort of 30 patients with serial disease. Δ FFR app underestimated Δ FFR true in 88% of phantoms, with underestimation proportional to total FFR . Discrepancy as a proportion of Δ FFR true was 17.1% (absolute difference 0.036±0.048), which improved to 2.9% (0.006±0.023) using our model. In the clinical cohort, discrepancy was 38.5% (0.05±0.04) with 13.3% of stenoses misclassified (using FFR <0.8 threshold). Using mathematical correction, this improved to 15.4% (0.02±0.03), with the proportion of misclassified stenoses falling to 6.7%. Conclusions Individual stenoses are considerably underestimated in serial disease, proportional to total FFR . We have shown within in vitro and clinical cohorts that this error is significantly improved using a mathematical correction model, incorporating routinely available pressure-wire pullback data. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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