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