Computational non-invasive physiological assessment of coronary disease

Summary

Coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) are key components in the documentation of coronary artery disease. It is however evident that sole anatomical evaluation with CCTA and ICA fails to expose the hemodynamic importance of epicardial coronary artery disease. As consequence, invasive wire-based solutions for physiological assessment (FFR, iwFR) were developed to identify ischemia-producing epicardial coronary stenosis. Despite the overall trend towards more physiology-guided revascularization, the clinical adoption of functional stenosis evaluation is inadequate. Coronary image-based computational physiology was therefore introduced for evaluation of epicardial coronary stenosis. Based on the current evidence, computational physiological assessment of coronary artery disease provides solid estimates of FFR, with the potential to improve the gatekeeper function to the catheterization laboratory, plan revascularization of epicardial coronary artery disease, optimize PCI results, and expand the use of physiology-guided coronary interventions on a global level.

Introduction

Over the last two decades, invasive pressure-derived fractional flow reserve (FFR) has become the standard test for revealing the ischemic potential of a coronary stenosis 11. Pijls NH, van Schaardenburgh P, Manoharan G, Boersma E, Bech JW, van’t Veer M, Bar F, Hoorntje J, Koolen J, Wijns W, de Bruyne B. Percutaneous coronary...