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Angio-‐based FFR in straight vessels and bifurca7ons: QFR
Johan HC Reiber, PhD
Shengxian (Sanven) Tu, PhD
Medis medical imaging systems bv Leiden, The Netherlands
Division of Image Processing (LKEB), Dept of Radiology
Leiden University Medical Center
School of Biomedical Engineering Shanghai Jiao Tong University
3D QCA by QAngio XA 3D Research Edi7on 1.0 (Medis Specials, Leiden)
FFRQCA: One-‐stop shop?
QFR (Medis’ QCA derived FFR)
Based on EuroPCR presenta7on by Niels Holm, Aarhus University Hospital, Skejby, Denmark
QFR = 0.87
FFR = 0.85
3D model reconstructed from 2 angiographic projections with angles ≥ 25º apart, acquired by monoplane or biplane
systems.
Patient-specific volumetric flow rate (at hyperemia) calculated using the combination of contrast bolus front frame count and
3D QCA;
QFR (Medis’ QCA derived FFR)
Based on all available information, QFR is calculated in 2 s
Vessel QFR = 0.61
Lesion QFR = 0.62
Index QFR = 0.66
FFRQCA study
FFRQCA study: characteris7cs
intermediate
de novo
lesions
Difference: 0.00 ± 0.06 (p = 0.541)
FFRQCA versus FFR
Tu et al. JACC Cardiovasc Interv 2014, 7:768-777.
Dedicated bifurca7on QCA
Bifurcation fractal laws Law Relationship
Murray
Finet
HK
Dm
Dd1
Dd2
New quan7ta7ve bifurca7on model
Tu et al. JACC Cardiovasc Interv, 2015; 8: 564-74.
Dedicated bifurca7on QCA
Tu et al. JACC Cardiovasc Interv, 2015, 8: 564-74.
Statistics from 78 bifurcation lesions
QFR = 0.78
vs.
FFR = 0.78
QFR pullback
mmHg
QFR for bifurca7on
Next steps QFR:
Ø Finalized recruitment of another 80 patients in multi-center setting for optimizing algorithms;
Ø Testing prototype software in cath labs of KOLs. Anticipated processing time per case < 2 min in clinical setting;
Ø Defining additional clinical trials to determine sensitivity/specificity in on-line setting and an Outcome trial.
Ø Available as imaging vendor independent commercial product in Q1 2016;
QFR
Optimize algorithm Hyperaemia needed?
Thorough prospective validation
Automatization - Integration – User interface
To do:
Based on EuroPCR presenta7on by Niels Holm, Aarhus University Hospital, Skejby, Denmark
QFR
• QFR by angiography may improve safety, facilitate global adoption of FFR and reduce costs
• QFR comes with much more than an FFR value • Flow assessment • Shear stress analysis • Optimal projection angles • Stent sizing tool • Co-registration
• Clinical validation of QFR is ongoing
Conclusion
Based on EuroPCR presenta7on by Niels Holm, Aarhus University Hospital, Skejby, Denmark
QFR
• QFR by angiography may improve safety, facilitate global adoption of FFR and reduce costs
• QFR comes with much more than an FFR value • Flow assessment • Shear stress analysis • Optimal projection angles • Stent sizing tool • Co-registration
• Clinical validation of QFR is ongoing
Conclusion
Based on EuroPCR presenta7on by Niels Holm, Aarhus University Hospital, Skejby, Denmark
QFR
• QFR by angiography may improve safety, facilitate global adoption of FFR and reduce costs
• QFR comes with much more than an FFR value • Flow assessment • Shear stress analysis • Optimal projection angles • Stent sizing tool • Co-registration
• Clinical validation of QFR is ongoing
Conclusion
Based on EuroPCR presenta7on by Niels Holm, Aarhus University Hospital, Skejby, Denmark
QAngioOCT co-‐registra7on
Acknowledgements Ø William Wijns, Cardiovascular Centre Aalst;
Ø Niels R. Holm, Aarhus University Hospital;
Ø Yingguang Li, Medis & Leiden University Medical Center;
Ø Junqing Yang, Guangdong General Hospital;
Ø Stylianos A. Pyxaras, Cardiovascular Centre Aalst;
Ø Emanuele Barbato, Cardiovascular Centre Aalst;
Ø Clemens von Birgelen, Medisch Spectrum Twente
Ø Holger Nef, Clinic Giessen & Marburg
Ø Jelmer Westra, Aarhus University Hospital