The importance of three dimensional coronary artery reconstruction accuracy when computing virtual fractional flow reserve from invasive angiography

Solanki, Roshni, Gosling, Rebecca, Rammohan, Vignesh, Pederzani, Giulia, Garg, Pankaj ORCID:, Heppenstall, James, Hose, D. Rodney, Lawford, Patricia V., Narracott, Andrew J., Fenner, John, Gunn, Julian P. and Morris, Paul D. (2021) The importance of three dimensional coronary artery reconstruction accuracy when computing virtual fractional flow reserve from invasive angiography. Scientific Reports, 11. ISSN 2045-2322

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Three dimensional (3D) coronary anatomy, reconstructed from coronary angiography (CA), is now being used as the basis to compute ‘virtual’ fractional flow reserve (vFFR), and thereby guide treatment decisions in patients with coronary artery disease (CAD). Reconstruction accuracy is therefore important. Yet the methods required remain poorly validated. Furthermore, the magnitude of vFFR error arising from reconstruction is unkown. We aimed to validate a method for 3D CA reconstruction and determine the effect this had upon the accuracy of vFFR. Clinically realistic coronary phantom models were created comprosing seven standard stenoses in aluminium and 15 patient-based 3D-printed, imaged with CA, three times, according to standard clinical protocols, yielding 66 datasets. Each was reconstructed using epipolar line projection and intersection. All reconstructions were compared against the real phantom models in terms of minimal lumen diameter, centreline and surface similarity. 3D-printed reconstructions (n = 45) and the reference files from which they were printed underwent vFFR computation, and the results were compared. The average error in reconstructing minimum lumen diameter (MLD) was 0.05 (± 0.03 mm) which was < 1% (95% CI 0.13–1.61%) compared with caliper measurement. Overall surface similarity was excellent (Hausdorff distance 0.65 mm). Errors in 3D CA reconstruction accounted for an error in vFFR of ± 0.06 (Bland Altman 95% limits of agreement). Errors arising from the epipolar line projection method used to reconstruct 3D coronary anatomy from CA are small but contribute to clinically relevant errors when used to compute vFFR.

Item Type: Article
Additional Information: Funding Information: RG, VR and GP were supported by the British Heart Foundation (FS/16/48/32306, TG/19/1/34451). PDM and PG were supported by the Wellcome Trust [214567/Z/18/Z, 220703/Z/20/Z]. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 14 Oct 2021 01:12
Last Modified: 31 Jan 2024 03:13
DOI: 10.1038/s41598-021-99065-7

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