Coronary fractional flow reserve derived from intravascular ultrasound

$Coronary fractional flow reserve derived from intravascular ultrasound imaging (IVUSFR): Validation of a new$

Alexandre Hideo-Kajita, MD I have no relevant financial relationships

BACKGROUND / OBJECTIVE BACKGROUND: § The determination of the ischemic status of a coronary

METHODS Inclusion Criteria § Stable CAD; § Scheduled for elective cardiac catheterization; § Presence

METHODS: § Acquisition and Offline analysis - IVUS, Angio and FFRINVASIVE • Heart Institute

ACQUISITION Stable CAD Patients Angiographic assessment* (Intermediate lesion) * Same procedure. + IVUS* +

3 D mesh of a coronary artery based on Grayscale IVUS Acquisition Orthogonal views

ACTUAL CASE Angio + FFRINVASIVE %DS = 60 FFRINVAS = 0. 91 IVUSFR =

RESULTS Table 1: Baseline characteristics. (n = 24) 59. 4 (53. 0– 68. 3)

RESULTS Table 2: Lesion Characteristics. (n = 34) Target lesions 5/34 (14. 7%) RCA

LIMITATIONS / CONCLUSION LIMITATIONS: § An exploratory study with small sample size. § The

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$Coronary fractional flow reserve derived from intravascular ultrasound imaging (IVUSFR): Validation of a new$

Coronary fractional flow reserve derived from intravascular ultrasound imaging (IVUSFR): Validation of a new computational method. Alexandre Hideo-Kajita MD Presenting on behalf of Pedro A. Lemos MD, Ph. D. Cristiano G. Bezerra MD, Ph. D; Alexandre Hideo-Kajita MD; Carlos A. Bulant DSc; Gonzalo D. Maso-Talou DSc; Jose Mariani Jr MD; Fabio A. Pinton MD; Breno A. A. Falcão MD, Ph. D; Antônio Esteves-Filho MD; Marcelo Franken MD, Ph. D; Raúl A. Feijóo DSc; Roberto Kalil-Filho MD, Ph. D; Hector M. Garcia-Garcia MD, Ph. D; Pablo J. Blanco DSc; Pedro A. Lemos MD, Ph. D. March, 3 rd 2019 Bezerra C et al. Catheter Cardiovasc Interv. 2019 Feb 1; 93(2): 266 -274.

Alexandre Hideo-Kajita, MD I have no relevant financial relationships

BACKGROUND / OBJECTIVE BACKGROUND: § The determination of the ischemic status of a coronary artery by wireless physiologic assessment derived from angiography has been validated and approved in the US. § Fractional flow reserve (FFR) and intravascular ultrasound (IVUS) imaging are considered as the “gold standard” for functional and anatomical assessments of angiographic intermediate stenosis, respectively. § A combined method of coronary mathematical blood flow model derived from grayscale IVUS was developed, offering the geometric advantages of IVUS and physiology assessment. OBJECTIVE: § To evaluate the diagnostic performance of IVUSFR compared to FFR.

METHODS Inclusion Criteria § Stable CAD; § Scheduled for elective cardiac catheterization; § Presence of a de novo lesion in at least 1 major epicardial vessel (DS of 40%– 80% by visual estimation); Exclusion Criteria § Left main coronary disease (DS >50%); § Clinical, angiographic or IVUS findings suggesting Acute Disease (thrombus or plaque rupture); § Severe Left ventricular dysfunction; § End-stage Chronic renal disease; § Surgical graft in the target vessel.

METHODS: § Acquisition and Offline analysis - IVUS, Angio and FFRINVASIVE • Heart Institute (In. Cor) - University of São Paulo, SP, BR • Sirio-Libanes Hospital - São Paulo, SP, BR § Data post processing - 3 D-IVUS mesh and IVUSFR • Blinded Comparison between IVUSFR and FFRINV. National Laboratory for Scientific Computing (LNCC) * The study protocol is approved by the ethics committees of the centers and is in accordance with the Helsinki Declaration.

ACQUISITION Stable CAD Patients Angiographic assessment* (Intermediate lesion) * Same procedure. + IVUS* + FFR* DATA PROCESSING 24 patients (34 lesions/vessels) In. Cor IVUS, Angio and FFR 3 D IVUS and IVUSFR FFR versus IVUSFR (n = 34 lesions) LNCC

3 D mesh of a coronary artery based on Grayscale IVUS Acquisition Orthogonal views Projection A Projection B Grayscale IVUS Coronary Angio Gating Segmentation Reconstruction

ACTUAL CASE Angio + FFRINVASIVE %DS = 60 FFRINVAS = 0. 91 IVUSFR = 0. 91

RESULTS Table 1: Baseline characteristics. (n = 24) 59. 4 (53. 0– 68. 3) 21 (87. 5%) 27. 5 (25. 2– 30. 6) Age (years) Male Body mass index (kg/m 2) Risk Factors Hypertension 15 (62. 5%) Current smoker 9 (37. 5%) 10 (41. 7%) Diabetes mellitus Previous PCI 2 (8. 3%) Previous CABG 1 (4. 2%) Clinical presentation Stable Angina 8 (33. 3%) Silent ischemia 16 (66. 7%) 64. 5 (62. 0– 68. 0) Left ventricle ejection fraction (%) Heart rate (bpm) 70. 0 (64. 5– 76. 5) Mean systemic arterial pressure (mm. Hg) 86. 0 (74. 3– 91. 8) Numbers are counts (percentage) or median (interquartile range).

RESULTS Table 2: Lesion Characteristics. (n = 34) Target lesions 5/34 (14. 7%) RCA LMCA 0/34 (0. 0%) 21/34 (61. 8%) LAD 8/34 (23. 5%) LCx 13/34 (38. 2%) Eccentric lesions Calcification (moderate/severe) 7/34 (20. 6%) Tortuosity (moderate/severe) 13/34 (38. 2%) ACC/AHA Lesion Classification 3/34 (8. 8%) Type A 13/34 (38. 2%) Type B 1 8/34 (23. 5%) Type B 2 10/34 (29. 4%) Type C FFRINVASIVE 0. 89 (0. 80– 0. 95) Lesion length (mm), mean±SD 10. 6± 5. 4 Reference vessel diameter (mm), median(IQR) 2. 9 (2. 5– 3. 3) Minimum lumen diameter (mm), median(IQR) 1. 6 (1. 4– 2. 0) IVUS MLA (mm 2), median(IQR) 3. 6 (2. 9– 5. 1) 2 IVUS external elastic membrane area (mm ), median(IQR) 12. 1 (9. 1– 16. 1) IVUS plaque burden (%), median(IQR) 67. 0 (60. 8– 74. 3) Numbers are counts (percentage) or median (interquartile range).

RESULTS

LIMITATIONS / CONCLUSION LIMITATIONS: § An exploratory study with small sample size. § The IVUSFR version used in this analysis was still an offline tool. § High computational time/cost. CFD was used to derive flow in this IVUSFR version. CONCLUSION: § The computational processing of IVUSFR showed satisfactory agreement with FFRINVASIVE enriching the anatomical information of grayscale IVUS.