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Войти в исследования Cardiovascular revascularization medicine : including molecular interventions · 2025
Comparison of predicted post-PCI FFR derived from coronary computed tomography angiography versus observed angiographic FFR: emerging concept of wireless end-to-end physiology-guided PCI.
СтатьяСравнительное исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Carvalho Pedro E P, Cavalcante João L, Lesser John, Cheng Victor, Strepkos Dimitrios, Alexandrou Michaella, Mastrodemos Olga, Rangan Bavana V, Brilakis Emmanouil S, Sandoval Yader
Аннотация
BACKGROUND: Fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) facilitates virtual PCI planning and informs stent length selection based on predicted post-PCI FFRCT. This approach was previously validated against pressure-wire based FFR. Whether angiographic FFR can be used to ascertain the target post-PCI FFRCT predicted from CCTA is uncertain.
METHODS: Observational cohort study of patients undergoing coronary computed tomography angiography (CCTA) with an FFRCT ≤ 0.80 that were referred to CCTA-guided PCI using the FFRCT-based virtual planner (HeartFlow Inc.) for pre-procedural guidance and FFRangio (CathWorks Ltd.) for intra- and post-procedural assessment. Virtual FFR pullbacks (FFR measurements every 1 mm across the vessel length) were analyzed and compared for both FFRCT and FFRangio modalities. We evaluated the agreement between pre- and post-PCI FFRCT and FFRangio at matched locations using the Pearson correlation coefficient and Bland-Altman analysis. Virtual FFR pullbacks (FFR measurements every 1 mm across the vessel length) were analyzed and compared for both FFRCT and FFRangio modalities.
RESULTS: A total of 2290 post-PCI FFR values were derived from 20 vessels that underwent CCTA-guided PCI virtual PCI followed by post-PCI FFRangio. FFR values were matched across FFR pullback tracings that allowed the comparison of predicted post-PCI FFRCT to observed post PCI FFRangio results. The left anterior descending artery (LAD) (45 %) was the most common target vessel. A strong correlation was observed between FFRCT and FFRangio (R = 0.74; p < 0.001). The mean difference at matched locations was -0. 01 FFR units, with a standard deviation of 0.04 and limits of agreement ranging from -0.10 to 0.07.
CONCLUSION: Predicted post-PCI FFRCT values derived from CCTA-based virtual PCI have an excellent correlation with observed post-PCI FFRangio values derived from invasive coronary angiography after stenting. These findings highlight the novel concept of wireless end-to-end physiology guided PCI, integrating pre-PCI FFRCT and post-PCI angiographic FFR as complementary tools.
METHODS: Observational cohort study of patients undergoing coronary computed tomography angiography (CCTA) with an FFRCT ≤ 0.80 that were referred to CCTA-guided PCI using the FFRCT-based virtual planner (HeartFlow Inc.) for pre-procedural guidance and FFRangio (CathWorks Ltd.) for intra- and post-procedural assessment. Virtual FFR pullbacks (FFR measurements every 1 mm across the vessel length) were analyzed and compared for both FFRCT and FFRangio modalities. We evaluated the agreement between pre- and post-PCI FFRCT and FFRangio at matched locations using the Pearson correlation coefficient and Bland-Altman analysis. Virtual FFR pullbacks (FFR measurements every 1 mm across the vessel length) were analyzed and compared for both FFRCT and FFRangio modalities.
RESULTS: A total of 2290 post-PCI FFR values were derived from 20 vessels that underwent CCTA-guided PCI virtual PCI followed by post-PCI FFRangio. FFR values were matched across FFR pullback tracings that allowed the comparison of predicted post-PCI FFRCT to observed post PCI FFRangio results. The left anterior descending artery (LAD) (45 %) was the most common target vessel. A strong correlation was observed between FFRCT and FFRangio (R = 0.74; p < 0.001). The mean difference at matched locations was -0. 01 FFR units, with a standard deviation of 0.04 and limits of agreement ranging from -0.10 to 0.07.
CONCLUSION: Predicted post-PCI FFRCT values derived from CCTA-based virtual PCI have an excellent correlation with observed post-PCI FFRangio values derived from invasive coronary angiography after stenting. These findings highlight the novel concept of wireless end-to-end physiology guided PCI, integrating pre-PCI FFRCT and post-PCI angiographic FFR as complementary tools.