Functional assessment of lesion severity without using the pressure wire: coronary imaging and blood flow simulation
Autor: | Michail I. Papafaklis, Lampros Lakkas, Dimitrios I. Fotiadis, Lampros K. Michalis, Panagiotis K. Siogkas, Christos S. Katsouras, Michail C. Mavrogiannis |
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Rok vydání: | 2017 |
Předmět: |
Coronary angiography
medicine.medical_specialty Coronary imaging Hemodynamics Fractional flow reserve 030204 cardiovascular system & hematology Coronary Angiography 03 medical and health sciences 0302 clinical medicine Internal Medicine Medical imaging Medicine Humans 030212 general & internal medicine business.industry Coronary Stenosis Models Cardiovascular General Medicine Blood flow Pressure wire Fractional Flow Reserve Myocardial Treatment Outcome Radiology Cardiology and Cardiovascular Medicine business Coronary physiology Tomography X-Ray Computed |
Zdroj: | Expert review of cardiovascular therapy. 15(11) |
ISSN: | 1744-8344 |
Popis: | Hemodynamic indices derived from measurements with the pressure wire (primarily fractional flow reserve [FFR]) have been established as a reliable tool for assessing coronary stenoses and improving clinical decision making. However, the use of the pressure wire constitutes a hurdle for the universal adoption of physiology-guided patient management. Technological advancements have enabled the large-scale application of blood flow simulation (computational fluid dynamics [CFD]) to medical imaging, thereby enabling the virtual assessment of coronary physiology. Areas covered: This review summarizes the stand-alone non-invasive (coronary computed tomographic imaging) and invasive (coronary angiography) imaging approaches which were initially used for predicting FFR, and focuses on the use of blood flow modeling for functional assessment of coronary lesions in clinical practice. Expert commentary: Validation studies of CFD-derived methodologies for functional assessment have shown that virtual indices correlate well and have good diagnostic accuracy compared to pressure wire-FFR despite inherent limitations of spatial resolution and assumptions regarding boundary conditions in flow modeling. Beyond point-to-point agreement with FFR, further studies are needed to demonstrate the clinical safety/efficacy of these computational tools regarding patient outcomes. Such evidence base could support the incorporation of these methodologies into routine patient management for decision making and reliable risk stratification. |
Databáze: | OpenAIRE |
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