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Evaluation of functional significance of coronary arteries stenoses with estimation of fractional flow reserve based on computed tomography angiography data

https://doi.org/10.38109/2075-082X-2024-2-41-47

Abstract

   Relevance. In patients with coronary artery disease (CAD) it is necessary to evaluate the functional significance of coronary tree lesion for determining of
management and indications for myocardial revascularization. During invasive coronary angiography (ICA) it can be made by measurement of fractional flow
reserve (FFR), which is called the «gold standard» of functional significance of coronary artery (CA) evaluation. For noninvasive visualization of CA is used coronary computed tomography angiography (CTA). The method of definition of FFR based on CTA data (FFRCT) – HeartFlow FFR-CT (HeartFlow, Redwood City, СА) has proved diagnostic accuracy and includes in clinical guidelines of American College of Cardiology. In Russian Federation there is no a software for FFRCT estimation, so algorithms are developed for this computation.

   Purpose. To provide comparative analysis of FFRCT and invasive measuring FFR (FFRINV) in patients with moderate stenoses of CA.

   Materials and methods. In trial included 20 patients with chest pain and suspected or known ischemic heart disease (IHD). As usual clinical and instrumental care was provided and acute myocardial infarction was excluded CTA on 640-slises computed tomography was performed. If CTA determine in one CA a moderate stenosis (50-85 %) the three-dimensional mathematical model of coronary tree was created with domestic algorithms of FFRCT calculation. FFRCT compared with FFRINV data, the mean of FFRINV equal or less than 0,8 indicated the functional significance of CA stenosis.

   Results. In final analysis of FFRCT and FFRINV parameters were included 13 patients. In 35 % cases a mathematical model for FFRCT calculation was not created because of severe calcification of CA. Correlation analysis shows the strong and statistically significant association between FFRCT and FFRINV parameters. Pearson coefficient is 0,86.

   Conclusions. Derived results revealed a good correlation between FFRCT and FFRINV in identifying of functional significance of CA stenoses. Despite of some limitations, method of noninvasive FFR calculation based on CTA data is a perspective direction of noninvasive examination development in patients with IHD. For future studying and using of method it is necessary to make algorithm of FFRCT calculation automatically and to provide trials with more including participants.

About the Authors

A. A. Balakhonova
A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology
Russian Federation

Anastasia A. Balakhonova, Cardiologist, Postgraduate

A.L. Myasnikov Scientific research institute of clinical cardiology; Emergency Cardiology Department

121552; St. Academician Chazova, 15 a; Moscow


T. N. Veselova
A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology
Russian Federation

Tatiana N. Veselova, Dr. Of Sci. (Med.), Leading Researcher

A.L. Myasnikov Institute of Clinical Cardiology; Computed Tomography Department

121552; St. Academician Chazova, 15 a; Moscow


T. S. Sukhinina
A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology
Russian Federation

Tatyana S. Sukhinina, Cand. Of Sci. (Med.), Senior Researcher

A.L. Myasnikov Scientific research institute of clinical cardiology; Emergency Cardiology Department

121552; St. Academician Chazova, 15 a; Moscow


E. R. Blagosklonova
Gammamed-Soft Ltd
Russian Federation

Evgenia R. Blagosklonova, Senior Research Scientist

127473;  3d Samotyochny Lane; Moscow


M. D. Kalugina
Tesis Ltd, St. Yunnatov
Russian Federation

Maria D. Kalugina, Engineer

127083; St. Yunnatov, 18; Moscow


A. V. Gavrilov
M.V. Lomonosov Moscow State University
Russian Federation

Andrey V. Gavrilov, Cand. Of Sci. (Tech.), Head of Laboratory

D.V. Skobeltsyn Institute of nuclear physics; Laboratory of Medical Computing System

119991; Leninskiye Gory, 1; Moscow


A. A. Aksenov
Tesis Ltd, St. Yunnatov
Russian Federation

Andrey A. Aksenov, Cand. Of Sci. (Phys.–Math.), Technical Director

127083; St. Yunnatov, 18; Moscow


A. I. Lobanov
Moscow Institute for Physics and Technology
Russian Federation

Alexey I. Lobanov, Dr. Of Sci. (Phys.–Math.)

141701; Institutsky Lane, 9; Moscow Rerion; Dolgoprudny


G. K. Arutunyan
A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology
Russian Federation

Gohar K. Arutunyan, Cand. Of Sci. (Med.), Researcher

 A.L. Myasnikov Scientific research institute of clinical cardiology

Department of X-ray Endovascular Methods of Diagnosis and Treatment

121552; St. Academician Chazova, 15 a; Moscow


D. V. Pevzner
A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology
Russian Federation

Dmitry V. Pevzner

121552; St. Academician Chazova, 15 a; Moscow


S. K. Ternovoy
A.L. Myasnikov Scientific research institute of clinical cardiology, E.I. Chazov National Medical Research Center of cardiology; I.M. Sechenov First Moscow State Medical University
Russian Federation

Sergey K. Ternovoy

121552; St. Academician Chazova, 15 a; 119048; St. Trubetskaya, 8/2; Moscow


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Review

For citations:

Balakhonova A.A., Veselova T.N., Sukhinina T.S., Blagosklonova E.R., Kalugina M.D., Gavrilov A.V., Aksenov A.A., Lobanov A.I., Arutunyan G.K., Pevzner D.V., Ternovoy S.K. Evaluation of functional significance of coronary arteries stenoses with estimation of fractional flow reserve based on computed tomography angiography data. Systemic Hypertension. 2024;21(2):43-49. (In Russ.) https://doi.org/10.38109/2075-082X-2024-2-41-47

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