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Estimating the accuracy of a reduced-order model for the calculation of fractional flow reserve (FFR) / Etienne Boileau; Sanjay Pant; Carl Roobottom; Igor Sazonov; Jingjing Deng; Xianghua Xie; Perumal Nithiarasu

International Journal for Numerical Methods in Biomedical Engineering

Swansea University Author: Nithiarasu, Perumal

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DOI (Published version): 10.1002/cnm.2908

Abstract

Image-based non-invasive fractional flow reserve (FFR) is an emergent approach to determine the functional relevance of coronary stenoses. The present work aimed to determine the feasibility of using a method based on coronary computed tomography angiography (CCTA) and reduced-order models (0D-1D) f...

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Published in: International Journal for Numerical Methods in Biomedical Engineering
ISSN: 2040-7939
Published: 2017
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URI: https://cronfa.swan.ac.uk/Record/cronfa34554
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Abstract: Image-based non-invasive fractional flow reserve (FFR) is an emergent approach to determine the functional relevance of coronary stenoses. The present work aimed to determine the feasibility of using a method based on coronary computed tomography angiography (CCTA) and reduced-order models (0D-1D) for the evaluation of coronary stenoses. The reduced-order methodology (cFFRro) was kept as simple as possible and did not include pressure drop or stenosis models. The geometry definition was incorporated into the physical model used to solve coronary flow and pressure. cFFRro was assessed on a virtual cohort of 30 coronary artery stenoses in 25 vessels and compared with a standard approach based on 3D computational fluid dynamics (cFFR3D). In this proof-of-concept study, we sought to investigate the influence of geometry and boundary conditions on the agreement between both methods. Performance on a per-vessel level showed a good correlation between both methods (Pearson's product-moment R = 0.885, P < 0.01), when using cFFR3D as the reference standard. The 95% limits of agreement were -0.116 and 0.08, and the mean bias was -0.018 (SD =0.05). Our results suggest no appreciable difference between cFFRro and cFFR3D with respect to lesion length and/or aspect ratio. At a fixed aspect ratio, however, stenosis severity and shape appeared to be the most critical factors accounting for differences in both methods. Despite the assumptions inherent to the 1D formulation, asymmetry did not seem to affect the agreement. The choice of boundary conditions is critical in obtaining a functionally significant drop in pressure. Our initial data suggest that this approach may be part of a broader risk assessment strategy aimed at increasing the diagnostic yield of cardiac catheterisation for in-hospital evaluation of hæmodynamically significant stenoses.
Keywords: Non-invasive fractional flow reserve; reduced-order model; coronary stenosis severity, shape and asymmetry; boundary conditions
College: College of Engineering