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Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment
AIMS: To extend the benefits of physiologically guided percutaneous coronary intervention to many more 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 o...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242185/ https://www.ncbi.nlm.nih.gov/pubmed/34223175 http://dx.doi.org/10.1093/ehjdh/ztab012 |
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author | Lal, Katherine Gosling, Rebecca Ghobrial, Mina Williams, Gareth J Rammohan, Vignesh Hose, D Rod Lawford, Patricia V Narracott, Andrew Fenner, John Gunn, Julian P Morris, Paul D |
author_facet | Lal, Katherine Gosling, Rebecca Ghobrial, Mina Williams, Gareth J Rammohan, Vignesh Hose, D Rod Lawford, Patricia V Narracott, Andrew Fenner, John Gunn, Julian P Morris, Paul D |
author_sort | Lal, Katherine |
collection | PubMed |
description | AIMS: To extend the benefits of physiologically guided percutaneous coronary intervention to many more 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 AND RESULTS: Virtual fractional flow reserve 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). Two hundred and thirty-one 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%, intraclass 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. CONCLUSION: Virtual fractional flow reserve 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. |
format | Online Article Text |
id | pubmed-8242185 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-82421852021-07-01 Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment Lal, Katherine Gosling, Rebecca Ghobrial, Mina Williams, Gareth J Rammohan, Vignesh Hose, D Rod Lawford, Patricia V Narracott, Andrew Fenner, John Gunn, Julian P Morris, Paul D Eur Heart J Digit Health Original Articles AIMS: To extend the benefits of physiologically guided percutaneous coronary intervention to many more 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 AND RESULTS: Virtual fractional flow reserve 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). Two hundred and thirty-one 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%, intraclass 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. CONCLUSION: Virtual fractional flow reserve 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. Oxford University Press 2021-02-05 /pmc/articles/PMC8242185/ /pubmed/34223175 http://dx.doi.org/10.1093/ehjdh/ztab012 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Lal, Katherine Gosling, Rebecca Ghobrial, Mina Williams, Gareth J Rammohan, Vignesh Hose, D Rod Lawford, Patricia V Narracott, Andrew Fenner, John Gunn, Julian P Morris, Paul D Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
title | Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
title_full | Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
title_fullStr | Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
title_full_unstemmed | Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
title_short | Operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
title_sort | operator-dependent variability of angiography-derived fractional flow reserve and the implications for treatment |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8242185/ https://www.ncbi.nlm.nih.gov/pubmed/34223175 http://dx.doi.org/10.1093/ehjdh/ztab012 |
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