Author + information
- Received February 12, 2015
- Revision received March 27, 2015
- Accepted April 23, 2015
- Published online July 1, 2015.
- Paul D. Morris, MBChB∗,†∗ (, )
- Frans N. van de Vosse, PhD‡,
- Patricia V. Lawford, PhD∗,
- D. Rodney Hose, PhD∗ and
- Julian P. Gunn, MD∗,†
- ∗Department of Cardiovascular Science, University of Sheffield, and Insigneo Institute for In Silico Medicine, Sheffield, United Kingdom
- †Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
- ‡Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- ↵∗Reprint requests and correspondence:
Dr. Paul D. Morris, Medical Physics Group, Department of Cardiovascular Science, University of Sheffield, The Medical School, Beech Hill Road, Sheffield S102RX, United Kingdom.
Fractional flow reserve (FFR) is the “gold standard” for assessing the physiological significance of coronary artery disease during invasive coronary angiography. FFR-guided percutaneous coronary intervention improves patient outcomes and reduces stent insertion and cost; yet, due to several practical and operator related factors, it is used in <10% of percutaneous coronary intervention procedures. Virtual fractional flow reserve (vFFR) is computed using coronary imaging and computational fluid dynamics modeling. vFFR has emerged as an attractive alternative to invasive FFR by delivering physiological assessment without the factors that limit the invasive technique. vFFR may offer further diagnostic and planning benefits, including virtual pullback and virtual stenting facilities. However, there are key challenges that need to be overcome before vFFR can be translated into routine clinical practice. These span a spectrum of scientific, logistic, commercial, and political areas. The method used to generate 3-dimensional geometric arterial models (segmentation) and selection of appropriate, patient-specific boundary conditions represent the primary scientific limitations. Many conflicting priorities and design features must be carefully considered for vFFR models to be sufficiently accurate, fast, and intuitive for physicians to use. Consistency is needed in how accuracy is defined and reported. Furthermore, appropriate regulatory and industry standards need to be in place, and cohesive approaches to intellectual property management, reimbursement, and clinician training are required. Assuming successful development continues in these key areas, vFFR is likely to become a desirable tool in the functional assessment of coronary artery disease.
- computational fluid dynamics
- computational modeling
- coronary angiography
- fractional flow reserve
- percutaneous coronary intervention
- virtual fractional flow reserve
Dr. Morris is funded by a British Heart Foundation Clinical Research Training Fellowship (R/134747-11-1). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 12, 2015.
- Revision received March 27, 2015.
- Accepted April 23, 2015.
- 2015 American College of Cardiology Foundation
- Virtual FFR
- Computational Fluid Dynamics
- vFFR Derived From Computed Tomographic Coronary Angiography
- vFFR From Invasive Angiography
- Advantages of vFFR
- Boundary Conditions
- CFD Simulation
- Computation Time
- Model Complexity and Design
- Accuracy and Validation
- Commercial Considerations
- Trial Evidence and Clinical Considerations