Title :

Impact of an Interactive CT/FFRCT Interventional Planner on Coronary Artery Disease Management Decision Making

Author(s) :

van Belle, Eric [Auteur]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Raposo, Luis [Auteur]
Bravo Baptista, Sergio [Auteur]
Vincent, Flavien [Auteur]
Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011 [RNMCD]
Porouchani, Sina [Auteur]
Cosenza, Alessandro [Auteur]
Rogers, Campbell [Auteur]
Leipsic, Jonathon [Auteur]

Journal title :

JACC: Cardiovascular Imaging

Pages :

1068-1070

Publisher :

Elsevier/American College of Cardiology

Publication date :

2021-05

ISSN :

1936-878X

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

A fractional flow reserve derived from computed tomography (FFRCT) interactive planner (HeartFlow, Redwood City, California) that combines coronary CT angiography data with computational fluid dynamics from which a ...
Show more >A fractional flow reserve derived from computed tomography (FFRCT) interactive planner (HeartFlow, Redwood City, California) that combines coronary CT angiography data with computational fluid dynamics from which a theoretical, modeled, post-stent FFR has been derived was developed. It has previously been shown to have a good correlation with invasive FFR as measured after percutaneous coronary intervention (PCI) (1,2). The aim of the present study was to explore how the integration of this novel technology impacts decision making for performing revascularization. A total of 101 patients with at least 1 stenosis ≥40% narrowing (a threshold selected given previously published potential for abnormal physiology [3]), were included with FFRCT data and invasive coronary angiography (ICA). Patients provided explicit consent to allow this analysis. This study was approved by the institutional review boards or ethics panels from the relevant studies. To enable fast recalculation of FFRCT for different stent configurations at PCI, an accelerated method for updating FFRCT was used (1). The revascularization strategy was chosen by 3 experienced interventional cardiologists working as a panel and reaching decision by consensus. First, they provided a management strategy based on ICA. The available outcomes were: optimal medical treatment (OMT); additional invasive physiology data required to determine the appropriate strategy, PCI in 1 or more lesions; or coronary artery bypass surgery (CABG). Then, using the FFRCT interactive planning tool with computed values for alternate PCI strategies (based on different stent locations and length[s] on the 3-dimensional model), an updated, second FFRCT-based decision was agreed upon. The primary endpoint of the study was the difference in treatment plans between the 2 consensus decisions. Continuous variables are presented as median (interquartile range) and categorical variables as percentages. Paired Student's t-tests were performed, and a 2-sided p value < 0.05 was considered significant. The total number of stenoses in the 101 patients was 327 (3.24 ± 1.61 stenoses/patient). Based on ICA, the plan was that 63 of 101 patients would undergo PCI, with 87 stents recommended to cover 78 segments (105 lesions). ICA-defined multivessel disease (at least 1 stenosis ≥40% narrowing in 2 different vessel territories) was present in 85% of cases. Serial stenoses (≥2 lesions in a row in the same vessel territory) were present in 81% of patients and occurred more frequently in the left anterior descending coronary artery territory than in the left circumflex coronary artery or the right coronary artery (64%, 27%, and 26%, respectively).Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Collections :

• Récepteurs nucléaires, Maladies Cardiovasculaires et Diabète (RNMCD) - U1011

Source :

Harvested from HAL