PT - JOURNAL ARTICLE
AU - Morris, Paul D.
AU - Silva Soto, Daniel Alejandro
AU - Feher, Jeroen F.A.
AU - Rafiroiu, Dan
AU - Lungu, Angela
AU - Varma, Susheel
AU - Lawford, Patricia V.
AU - Hose, D. Rodney
AU - Gunn, Julian P.
TI - Fast Virtual Fractional Flow Reserve Based Upon Steady-State Computational Fluid Dynamics Analysis
DP - 2017 Aug 01
TA - JACC: Basic to Translational Science
PG - 434--446
VI - 2
IP - 4
4099 - http://www.basictranslational.onlinejacc.org/content/2/4/434.short
4100 - http://www.basictranslational.onlinejacc.org/content/2/4/434.full
SO - BTS2017 Aug 01; 2
AB - • Computed vFFR promises the benefits of physiological lesion assessment without the drawbacks limiting use of the invasive method.• Sophisticated, zero-dimension–coupled, transient, 3-dimensional CFD models provide high degrees of accuracy but are typically slow to compute, and models are sensitive to unknown physiological parameters such as myocardial resistance.• Based on paired steady-state CFD analyses, 2 mathematical methods (“steady” and “pseudotransient”) were developed that accelerate the computation of vFFR from >36 h to <4 min.• The pseudotransient method computed transient results, without the need for complex, and computationally expensive, full transient CFD analysis.• Sensitivity analysis demonstrated that the hyperemic myocardial resistance is the dominant influence on vFFR and not the geometry of the lesion itself.Fractional flow reserve (FFR)-guided percutaneous intervention is superior to standard assessment but remains underused. The authors have developed a novel “pseudotransient” analysis protocol for computing virtual fractional flow reserve (vFFR) based upon angiographic images and steady-state computational fluid dynamics. This protocol generates vFFR results in 189 s (cf >24 h for transient analysis) using a desktop PC, with <1% error relative to that of full-transient computational fluid dynamics analysis. Sensitivity analysis demonstrated that physiological lesion significance was influenced less by coronary or lesion anatomy (33%) and more by microvascular physiology (59%). If coronary microvascular resistance can be estimated, vFFR can be accurately computed in less time than it takes to make invasive measurements.