FFRangio: image-based fractional flow reserve during coronary angiography - Stéphane Fournier

1. FFRangio
Image-Based Fractional Flow Reserve
During Coronary Angiography
Stephane Fournier, MD
Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium
19.09.2017
Cardiovascular
Center
Aalst

2. • Nothing to disclose
Cardiovascular
Center
Aalst
Disclosures

3. Toth et al, Eur Heart J. 2014 Oct 21;35(40):2831-8
The relationship between
angiographic evaluation and
hemodynamic assessment is
weak.
Discordance between methods is
observed in more than one-third of
the lesions.
Cardiovascular
Center
Aalst
Background (1)

4. Tonino et al, N Engl J Med. 2009 Jan 15;360(3):213-24.
Routine FFR measurement
in patients undergoing PCI
significantly reduces the
rate of MACE
Cardiovascular
Center
Aalst
Background (2)

5. Adapted from Rigamonti et al,
EuroIntervention. 2017 May 15;13(Z):Z75-Z79
Cardiovascular
Center
Aalst
Background (2)
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
2010 2011 2012 2013 2014 2015
(FFR / PCI) / year in
Switzerland
(FFR / PCI) / year in Europe
Barbato et al,
EuroIntervention. 2017 May 15;13(Z):Z8-Z10
10%
15%

6. • FFR is underutilized
• Interrupted workflow - more time, resources, expense
• Technical considerations - balancing, drift, pullbacks, etc.
• Pharmacologic vasodilation – patient adverse events, time
Background (3)
Cardiovascular
Center
Aalst

7. FFRangio: Real time functional angiography
Cardiovascular
Center
Aalst
Background (4)

8. Routine angiograms
1
3D full tree & flow
analysis
2
FFRangio
color coded map
3
Cardiovascular
Center
Aalst
Background (5)

9. 184 patients
with CAD,
203 lesions
1
Blinded
FFRangio, off
site by core
lab
3
FFR in every
lesion
2
FFR
Validationstudy
On-linestudy
The same set of algorithms were used in both studies
53 patients
with CAD,
60 lesions
1
FFR in every
lesion
2
FFR
Blinded
FFRangio,
during
procedure
3
Cardiovascular
Center
Aalst
Methods
J Am Coll Cardiol. 2016 Nov 15;68(20):2235-2237
Circ Cardiovasc Interv. 2017 Sep;10(9)
Submitted

10. Age, mean ± SD 65.9 ± 9.5 61.8 ± 10.6
Male gender 67% 79%
BMI 26.8 ± 3.3 26.8 ± 3.3
Family history of CAD, % 33% 38%
Hypertension, % 67% 58%
Hypercholesterolemia, % 89% 77%
Diabetes, % 32% 32%
Smoking (current), % 17% 15%
Smoking (prior), % 23% 32%
Prior MI, % 19% 21%
Prior PCI, % 36% 40%
Cardiovascular
Center
Aalst
Results (1)
Validation study On-line study

11. Cardiovascular
Center
Aalst
Stable angina, % 71% 32%
Unstable angina % 18% 36%
NSTEMI, % 11% 21%
Radial access, % 74% 94%
Vessel
LAD / Diagonal
LCX / Marginal
RCA
58% / 1%
15% / 4%
19%
70% / 5%
13% / 5%
7%
FFR
Range
Mean
<0.80
0.70-0.90
0.75-0.85
0.50-0.97
0.85
35.9%
67%
35%
0.52-0.97
0.82
37.0%
78%
38%
Validation study On-line study
Results (2)

12. Key Results
Correlation: 0.90
BA limits: -0.096 ; +0.112
Sensitivity: 88%
Specificity: 95%
Accuracy: 93%
Cardiovascular
Center
Aalst
Results : Validation Study

13. Correlation: 0.9
95% CI: 0.95 – 0.97
Intra-operator variability:
Cardiovascular
Center
Aalst
Results : Validation Study

14. Cardiovascular
Center
Aalst
Results : On-line Study
Key Results
Correlation: 0.91
BA limits: -0.065 ; +0.070
Sensitivity: 86%
Specificty: 100%
Accuracy: 96%

15. Estimation of Diameter Stenosis:
Visual Estimation 2D-QCA FFRangio 3D-QCA
Min 20 23 22
Max 95 70 68
Avg 59.8±14.8 45.0±10.27 40.3±11.16
Cardiovascular
Center
Aalst
Results : AUC

16. Dist-RCA : FFR=0.84Mid-LAD : FFR=0.72 Intermediate : FFR=0.68
Cardiovascular
Center
Aalst
Example : a patient with 3VD

17. Cardiovascular
Center
Aalst
Example : a patient with 3VD

18. Cardiovascular
Center
Aalst
Example : a patient with 3VD

19. Dist-RCA : FFR=0.84
Mid-LAD : FFR=0.72
Intermediate : FFR=0.68
Cardiovascular
Center
Aalst
Dist-RCA : FFR=0.85
Mid-LAD : FFR=0.76
Intermediate : FFR=0.66
FFR : Angio FFR :
PCI
PCI
No PCI
PCI
PCI
No PCI
Example : a patient with 3VD

20. Cardiovascular
Center
Aalst
Conclusion
• Results of these first
clinical experiences are
encouraging
 Accuracy
 Reproducibility
 Operator independency
• May foster the rate of
FFR-based decisions
• Pivotal study starting
FFRangio = “co-registration” of anatomy and function