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Title: Analysis identifying minimal governing parameters for clinically accurate in silico fractional flow reserve
BackgroundPersonalized hemodynamic models can accurately compute fractional flow reserve (FFR) from coronary angiograms and clinical measurements (FFR baseline ), but obtaining patient-specific data could be challenging and sometimes not feasible. Understanding which measurements need to be patient-tuned vs. patient-generalized would inform models with minimal inputs that could expedite data collection and simulation pipelines. AimsTo determine the minimum set of patient-specific inputs to compute FFR using invasive measurement of FFR (FFR invasive ) as gold standard. Materials and MethodsPersonalized coronary geometries ( N = 50 ) were derived from patient coronary angiograms. A computational fluid dynamics framework, FFR baseline , was parameterized with patient-specific inputs: coronary geometry, stenosis geometry, mean arterial pressure, cardiac output, heart rate, hematocrit, and distal pressure location. FFR baseline was validated against FFR invasive and used as the baseline to elucidate the impact of uncertainty on personalized inputs through global uncertainty analysis. FFR streamlined was created by only incorporating the most sensitive inputs and FFR semi-streamlined additionally included patient-specific distal location. ResultsFFR baseline was validated against FFR invasive via correlation ( r = 0.714 , p < 0.001 ), agreement (mean difference: 0.01 ± 0.09 ), and diagnostic performance (sensitivity: 89.5%, specificity: 93.6%, PPV: 89.5%, NPV: 93.6%, AUC: 0.95). FFR semi-streamlined provided identical diagnostic performance with FFR baseline . Compared to FFR baseline vs. FFR invasive , FFR streamlined vs. FFR invasive had decreased correlation ( r = 0.64 , p < 0.001 ), improved agreement (mean difference: 0.01 ± 0.08 ), and comparable diagnostic performance (sensitivity: 79.0%, specificity: 90.3%, PPV: 83.3%, NPV: 87.5%, AUC: 0.90). ConclusionStreamlined models could match the diagnostic performance of the baseline with a full gamut of patient-specific measurements. Capturing coronary hemodynamics depended most on accurate geometry reconstruction and cardiac output measurement.  more » « less
Award ID(s):
1943036
PAR ID:
10616002
Author(s) / Creator(s):
; ; ;
Publisher / Repository:
Frontiers
Date Published:
Journal Name:
Frontiers in Medical Technology
Volume:
4
ISSN:
2673-3129
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
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