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Non-invasive assessment of vessel-specific coronary blood flow by computational analysis of intracoronary transluminal attenuation gradient

Session Poster session 1

Speaker Il Park

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : I Park (Seoul,KR), JH Choi (Seoul,KR), YG Bae (Seoul,KR), YJ Moon (Seoul,KR), JM Lee (Seoul,KR), JH Yang (Seoul,KR), YB Song (Seoul,KR), JY Hahn (Seoul,KR), SH Choi (Seoul,KR), HC Gwon (Seoul,KR), SH Lee (Seoul,KR)

I. Park1 , J.H. Choi1 , Y.G. Bae2 , Y.J. Moon2 , J.M. Lee1 , J.H. Yang1 , Y.B. Song1 , J.Y. Hahn1 , S.H. Choi1 , H.C. Gwon1 , S.H. Lee1 , 1Samsung Medical Center, Cardiology - Seoul - Korea Republic of , 2Computational Fluid Dynamics and Acoustics Laboratory, School of Mechanical Engineering, Korea Univ - Seoul - Korea Republic of ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 186-187

Background: The key role of coronary artery is supplying sufficient blood flow that contains vital materials such as oxygen orglucose required by myocardium. Therefore quantification of coronary blood flow (CBF) has paramount importance in the coronary physiology. However, absolute quantitation of vessel-specific CBF requires invasive cardiac catheterizationand use of intracoronary wires with Doppler, pressure, or temperature probes. Non-invasive measurement of vessel-specific CBF from widely available modality would be very useful in clinical risk stratification and decision making.

Methods: Computational flow dynamics modeling investigated therheological background of vessel-specific CBF derived from transluminal attenuation flow encoding (TAFE), which consisted of arterial input function of contrast, vasculardimension to be filled by contrast, and transluminal attenuation gradient (TAG)reflecting intracoronary kinetics of contrast. TAFE formula was calibrated andvalidated with myocardial blood flow (MBF) by perfusion CT. TAFE-derived vessel-specific CBF of normal and obstructive vessels were compared inseparated single-beat CCTA study. In both study, vessel-specific myocardialmass was calculated by %fractional myocardial mass (%FMM).

Results: In simulated model, TAFE-derived CBF matched well with computational CBF and decreased proportionally to the stenosis severity. In perfusion CT study (134 vessels, 30 patients), TAFE formula showed good correlation with absolute vessel-specific MBF (r=0.84). In single-beat CCTA study (287 vessels, 98 patient), TAFE-derived CBF decreased consistently according to the diameter stenosis (DS) of 0% to 70% (0.98 ml g-1 min-1 to 0.67 ml g-1 min-1, test for trend, p<0.01). The optimal cutoff of TAFE-derived CBF for DS≥50% was ≤0.89 ml g-1 min-1 and showed diagnostic performance with sensitivity 89%, specificity 66%, positive predictive value 46%, negative predictive value 95%, accuracy 71%.

Conclusions: TAFE enables easy-to-use non-invasive quantitative measurement of vessel-specific CBF from conventional CCTA. and shows good diagnostic performance for obstructive coronary artery disease compared to TAG. If we added TAFE to computational FFR, the performance of computational FFR would be improved.

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