Gosling, D.R.C., Adam, Z., Barmby, D.S. et al. (8 more authors) (2021) The impact of virtual fractional flow reserve and virtual coronary intervention upon treatment decisions in the cardiac catheter laboratory. Canadian Journal of Cardiology, 37 (10). pp. 1530-1538. ISSN 0828-282X
Abstract
Background
Using fractional flow reserve (FFR) to guide percutaneous coronary intervention for patients with coronary artery disease (CAD) improves clinical decision making but remains under-used. Virtual FFR (vFFR, computed from angiographic images) permits physiological assessment without a pressure wire and can be extended to virtual coronary intervention (VCI) facilitating treatment planning. This study investigated the effect of adding vFFR and VCI to angiography in patient assessment and management.
Methods
Two cardiologists independently reviewed clinical data and angiograms of 50 patients undergoing invasive management of coronary syndromes, and their management plans were recorded. The vFFRs were computed and disclosed, and the cardiologists submitted revised plans. Then, using VCI, the physiological results of various interventional strategies were shown, and further revision was invited.
Results
Disclosure of vFFR led to a change in strategy in 27%. VCI led to a change in stent size in 48%. Disclosure of vFFR and VCI resulted in an increase in operator confidence in their decision. Twelve cases were reviewed by six additional cardiologists. There was limited agreement in the management plans between cardiologists based upon either angiography (kappa=0.31) or vFFR (kappa=0.39).
Conclusions
vFFR has the potential to alter decision making, and VCI can guide stent sizing. However, variability in management strategy remains considerable between operators, even when presented with the same anatomical and physiological data.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2021 Published by Elsevier Inc. on behalf of Canadian Cardiovascular Society. Article available under the terms of the CC-BY licence (https://creativecommons.org/licenses/by/4.0/). |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Sheffield Teaching Hospitals |
Funding Information: | Funder Grant number The Wellcome Trust 214567/Z/18/Z |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 08 Jul 2021 06:37 |
Last Modified: | 21 Feb 2022 14:21 |
Status: | Published |
Publisher: | Elsevier BV |
Refereed: | Yes |
Identification Number: | 10.1016/j.cjca.2021.06.004 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:175379 |