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High precision invasive FFR , low‐cost invasive iFR , or non‐invasive CFR ?: optimum assessment of coronary artery stenosis based on the patient‐specific computational models
Author(s) -
Tajeddini Farshad,
Nikmaneshi Mohammad Reza,
Firoozabadi Bahar,
Pakravan Hossein Ali,
Ahmadi Tafti Seyed Hossein,
Afshin Hossein
Publication year - 2020
Publication title -
international journal for numerical methods in biomedical engineering
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.741
H-Index - 63
eISSN - 2040-7947
pISSN - 2040-7939
DOI - 10.1002/cnm.3382
Subject(s) - fractional flow reserve , stenosis , cardiology , medicine , coronary flow reserve , coronary artery disease , lumen (anatomy) , shear stress , artery , myocardial infarction , coronary angiography , mechanics , physics
The objective of this paper is to apply computational fluid dynamic (CFD) as a complementary tool for clinical tests to not only predict the present and future status of left coronary artery stenosis but also to evaluate some clinical hypotheses. In order to assess the present status of the coronary artery stenosis severity, and thereby selecting the most appropriate type of treatment for each patient, fractional flow reserve (FFR), instantaneous wave free‐ratio (iFR), and coronary flow reserve (CFR) are calculated. To examine FFR, iFR, and CFR results, the effect of geometric features of stenoses, including diameter reduction (%), lesion length (LL), and minimum lumen diameter (MLD), is studied on them. It is observed that FFR is a more conservative index than iFR and CFR to assess the severity of coronary stenosis. In addition, it is seen that FFR, iFR, and CFR decrease by increasing LL and decreasing MLD. Therefore, the morphological indices, LL/MLD and LL/MLD̂4, with the calculated conservative cut‐off values equal to 5.5 and 3.6, are considered. Next, some controversial clinical hypotheses about the assessment of the severity of coronary stenosis are evaluated numerically. These include the examination of FFR, iFR, and CFR accuracies, investigating the effect of coronary hyperemia on iFR, as well as the reliability of the hybrid iFR‐FFR decision‐making strategy. The presented numerical model can also be used as a predictive tool to identify the atherosuseptible sites of arteries by calculating the time‐averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT).