Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Fumiyasu Seike; Teruyoshi Uetani; Kazuhisa Nishimura; Hiroshi Kawakami; Haruhiko Higashi; Akira Fujii; Jun Aono; Takayuki Nagai; Katsuji Inoue; Jun Suzuki; Shinji Inaba; Takafumi Okura; Kazunori Yasuda; Jitsuo Higaki; Shuntaro Ikeda

doi:10.1253/circj.CJ-17-1042

Ischemic Heart Disease

Intravascular Ultrasound-Derived Virtual Fractional Flow Reserve for the Assessment of Myocardial Ischemia

Fumiyasu Seike, Teruyoshi Uetani, Kazuhisa Nishimura, Hiroshi Kawakami, Haruhiko Higashi, Akira Fujii, Jun Aono, Takayuki Nagai, Katsuji Inoue, Jun Suzuki, Shinji Inaba, Takafumi Okura, Kazunori Yasuda, Jitsuo Higaki, Shuntaro Ikeda

Author information

Fumiyasu Seike
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Teruyoshi Uetani
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Kazuhisa Nishimura
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Hiroshi Kawakami
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Haruhiko Higashi
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Akira Fujii
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Jun Aono
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Takayuki Nagai
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Katsuji Inoue
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Jun Suzuki
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Shinji Inaba
Department of Cardiology, Kitaishikai Hospital
Takafumi Okura
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Kazunori Yasuda
Department of Mechanical Engineering, Ehime University Graduate School of Science and Engineering
Jitsuo Higaki
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
Shuntaro Ikeda
Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine

Keywords: Fractional flow reserve, Intravascular ultrasound, Myocardial ischemia

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2018 Volume 82 Issue 3 Pages 815-823

DOI https://doi.org/10.1253/circj.CJ-17-1042

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Abstract

Background:Fractional flow reserve (FFR) is widely used for the assessment of myocardial ischemia. Intravascular ultrasound (IVUS) is an intracoronary imaging method that provides information about lumen and vessel morphology. Previous studies on the expanded use of IVUS to identify functional ischemia have noted an association between anatomy and physiology, but IVUS-derived minimum lumen area (MLA) has a weak-moderate correlation with myocardial ischemia compared with FFR. We developed a method to calculate FFR using IVUS-derived anatomical information for the assessment of myocardial ischemia. The aims of this study were to investigate the relationship between wire-based FFR and IVUS-derived FFR (IVUS-FFR) and to compare the usefulness of IVUS-FFR and IVUS-derived MLA for functional assessment.

Methods and Results:We retrospectively analyzed 50 lesions in 48 patients with coronary stenosis who underwent IVUS and FFR simultaneously. IVUS-FFR was calculated using our original algorithm and fluid dynamics. Mean percent diameter stenosis determined on quantitative coronary angiography and on FFR was 56.4±10.7 and 0.69±0.08, respectively. IVUS-FFR had a stronger linear correlation with FFR (R=0.78, P<0.001; root mean square error, 0.057 FFR units) than with IVUS-derived MLA (R=0.43, P=0.002).

Conclusions:IVUS-FFR may be a more valuable method to identify myocardial ischemia, compared with IVUS-derived MLA.

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