angiography based simulation of FFR

基于血管造影的 FFR 模拟

• 批准号: 468039736
• 负责人: Dr. Fabian Ammon
• 金额: --
• 依托单位: Medizinische Klinik 2 - Kardiologie, Angiologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2021
• 资助国家: 德国
• 起止时间: 2020-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/468039736?language=en
• 关键词: angiography; based; simulation; FFR

Atherosclerosis of the coronary arteries is one of the leading causes of morbidity and mortality in the Western world. The clinical presentation ranges from stable angina on exertion to myocardial infarction and sudden cardiac death. Outside of acute coronary syndrome, evidence of myocardial ischemia is generally required to establish the indication for revascularization of coronary stenosis. Various stress tests or examinations are used for this purpose. However, despite this recommendation, more than 40% of coronary angiographies are performed in stable patients without prior noninvasive evidence of ischemia. In the absence of noninvasive evidence of ischemia or if the association between ischemia and coronary stenosis is not clear, invasive coronary angiography offers the possibility to determine the "fractional flow reserve" (FFR) to obtain information about the hemodynamic relevance of coronary stenoses. In this method, an extremely thin wire carrying a pressure sensor at its tip is inserted into the coronary artery during coronary angiography and the blood pressure upstream and downstream of a coronary stenosis is compared after vascular dilatation has been achieved pharmacologically, usually with adenosine. If the quotient of poststenotic to prestenotic blood pressure is ≤0.8, hemodynamic relevance is present and patients benefit from revascularization.Based on the convincing evidence from studies, FFR measurement is listed as a class IA recommendation by the European Society of Cardiology for assessing the need for treatment of coronary stenosis.For several years, there have been scientific efforts to obtain information regarding the hemodynamic relevance of possible stenoses from invasive coronary angiography, which solely depicts the anatomy of the vessel lumen. Using different methodological approaches, several studies showed that fractional flow reserve can be simulated or calculated based on invasive coronary angiography.The purpose of this project is to scientifically evaluate angiography-based fractional flow reserve (FFRangio) simulation in order to contribute to the clinical validation of the method, to identify factors influencing diagnostic validity, and to enable further development of the method. New methods such as the FFRangio presented here must lead to robust results in order to be widely used in clinical practice. Therefore, the influence of the following parameters on the outcome of FFRangio and the correlation of FFRangio to established invasive FFR will be systematically evaluated:1. influence of cardiac phase2. influence of the frame rate 3. influence of stenosis localization4. inter-operator variability5. comparison of FFRangio with simulation of FFR from coronary CT angiography datasets.6. comparison of FFRangio with other invasive parameters for estimating the severity of coronary stenosis such as pd/pa, iFR, RFR.

冠状动脉粥样硬化是西方世界发病率和死亡率的主要原因之一。其临床表现从劳累时的稳定型心绞痛到心肌梗死和心源性猝死。除急性冠脉综合征外，通常需要心肌缺血的证据来确定冠状动脉狭窄血运重建的适应症。为此目的进行了各种压力测试或检查。然而，尽管有这一建议，超过40%的冠状动脉造影是在稳定的患者中进行的，没有先前的非侵入性缺血证据。在缺乏缺血的无创证据或缺血与冠状动脉狭窄之间的关联不明确的情况下，有创冠状动脉造影提供了确定“血流储备分数”（FFR）的可能性，以获得有关冠状动脉狭窄的血流动力学相关性的信息。在该方法中，在冠状动脉造影术期间，将在其尖端携带压力传感器的极细的导线插入冠状动脉中，并且在通常使用腺苷实现血管扩张后，比较冠状动脉狭窄的上游和下游的血压。如果狭窄后血压与狭窄前血压的比值≤0.8，则存在血流动力学相关性，患者可从血运重建中获益。基于令人信服的研究证据，FFR测量被欧洲心脏病学会列为IA类推荐，用于评估冠状动脉狭窄的治疗需求。多年来，已经进行了科学的努力，以从侵入性冠状动脉血管造影术获得关于可能狭窄的血液动力学相关性的信息，所述侵入性冠状动脉血管造影术仅描绘血管腔的解剖结构。多项研究表明，可以通过有创冠状动脉造影模拟或计算血流储备分数，本项目旨在对基于血管造影的血流储备分数（FFRangio）模拟进行科学评价，以促进该方法的临床验证，识别影响诊断有效性的因素，并使该方法能够进一步发展。新的方法，如FFRangio在这里提出的必须导致强大的结果，以便在临床实践中广泛使用。因此，将系统评价以下参数对FFRangio结果的影响以及FFRangio与已建立的有创FFR的相关性：1.心脏相位的影响2.帧速率的影响3.狭窄定位的影响4.操作员之间的差异5. FFRangio与来自冠状动脉CT血管造影的FFR模拟的比较。将FFRangio与其他有创参数（如pd/pa、iFR、RFR）进行比较，以估计冠状动脉狭窄的严重程度。