Lal, K., Gosling, R., Ghobrial, M. et al. (8 more authors) (2021) Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment. European Heart Journal - Digital Health, 2 (2). pp. 263-270. ISSN 2634-3916
Abstract
Aims
To extend the benefits of physiologically-guided percutaneous coronary intervention to many patients, angiography-derived or ‘virtual’ fractional flow reserve (vFFR) has been developed, in which FFR is computed, based upon the images, instead of being measured invasively. The effect of operator experience with these methods upon vFFR accuracy remains unknown. We investigated variability in vFFR results based upon operator experience with image-based computational modelling techniques.
Methods
vFFR was computed using a proprietary method (VIRTUheart) from the invasive angiograms of patients with coronary artery disease. Each case was processed by an expert (>100 vFFR cases) and a non-expert (<20 vFFR cases) operator and results were compared. The primary outcome was the variability in vFFR between experts and non-experts and the impact this had upon treatment strategy (PCI vs conservative management).
Results
231 vessels (199 patients) were processed. Mean non-expert and expert vFFRs were similar overall (0.76 (0.13) and 0.77 (0.16)) but there was significant variability between individual results (variability coefficient 12%, intra-class correlation coefficient 0.58), with only moderate agreement (κ = 0.46), and this led to a statistically significant change in management strategy in 27% of cases. Variability was significantly lower, and agreement higher, for expert operators; a change in their recommended management occurred in 10% of repeated expert measurements and 14% of inter-expert measurements.
Conclusions
vFFR results are influenced by operator experience of vFFR processing. This had implications for treatment allocation. These results highlight the importance of training and quality assurance to ensure reliable, repeatable vFFR results.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
Keywords: | angiogram; percutaneous coronary intervention; coronary arteriosclerosis; fractional coronary flow reserve; computer simulation; conservative treatment; primary outcome measure |
Dates: |
|
Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 22 Mar 2021 15:54 |
Last Modified: | 17 Feb 2022 13:52 |
Status: | Published |
Publisher: | Oxford University Press (OUP) |
Refereed: | Yes |
Identification Number: | 10.1093/ehjdh/ztab012 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:171638 |