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PCI & AimRadial 2018 | FFR-CT - Colin Berry

1. FFR-CT Prof. Colin Berry Golden Jubilee National Hospital University of Glasgow, UK. AIMRADIAL – Westin Sarasota 29 November 2018 2. Disclosures Institutional…
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  • 1. FFR-CT Prof. Colin Berry Golden Jubilee National Hospital University of Glasgow, UK. AIMRADIAL – Westin Sarasota 29 November 2018
  • 2. Disclosures Institutional agreements between the University of Glasgow (employer) and Abbott Vascular, AstraZeneca, Coroventis, DalCor, GSK, HeartFlow, Novartis, Philips and Siemens Healthcare. TSC Member, PRECISION, DECISION Trials
  • 3. 1. Principles 2. Clinical studies 3. New methods: CT-FFR FFR-CT
  • 4. FFR-CT increases positive predictive value of CTCA Norgaard BL, Taylor CA et al Curr Cardiovasc Imaging Rep 2016 FFR-CT: Non-invasive computation of FFR in all major coronary arteries, personalised models
  • 5. FFR-CT vs. CTCA Landmark diagnostic accuracy studies Knappen et al EuroPCR.2018
  • 6. Dreissen, Knappen et al PACIFIC, EuroPCR.2018
  • 7. PACIFIC Dreissen, Knappen et al PACIFIC, EuroPCR.2018
  • 8. PACIFIC Dreissen, Knappen et al PACIFIC, EuroPCR.2018
  • 9. PACIFIC - Conclusions Dreissen, Knappen et al PACIFIC, EuroPCR.2018
  • 10. NHS Chest Pain Clinic, n = 1400 Primary endpoint: resource utilisation at 9 months including non- invasive cardiac investigations, invasive coronary angiography (ICA), coronary revascularization, hospitalisation for cardiac events and cardiac medications PIs: Curzen, Berry, Hlatky et al The FORECAST Trial: FFR Derived from CTCA in the Assessment and Management of Stable Chest Pain IIS grant
  • 11. PRECISION (PI, Dr Pam Douglas) Prospective Randomized Trial of the Optimal Evaluation of Cardiac Symptoms and Revascularization. Stable chest pain, clinic Precision strategy FFR-CT vs. SoC stress test strategy; health outcomes DECISION (PI, Dr Gregg Stone) Decisive evaluation of cardiac ischemia, symptoms and revascularisation FFR-CT vs. invasive angiography; ~ 5000 patients; health outcome trial Upcoming clinical trials
  • 12. • Stress – force per unit area, dynes/cm2 • Wall shear stress (WSS) – tangential force per unit area acting at endothelium; related to flow and viscosity • Axial plaque stress (APS) – at the plaque; related to pressure, transmural, ~x50  vs. WSS • Derived from patient-specific computed models • Clinical significance APS – EMERALD study Coronary biomechanics
  • 13. FFR-CT: Coronary biomechanics Case example: cardiac arrest survivor Norgaard BL, Taylor CA et al Curr Cardiovasc Imaging Rep 2016
  • 14. Novel applications in development – PCI planner Kim KH et al JACC CV Interv 2014 FFR-CT: Guide revascularisation FFR: Stenosis pre Simulation Post-PCI
  • 15. Other technologies CT-FFR AIMRADIAL – Westin Sarasota 29 November 2018
  • 16. Ko B et al JACC CV Imaging 2017 CT- FFR
  • 17. CT- FFR Ko B et al JACC CV Imaging 2017User generated FFR, ~1 hr
  • 18. Distribution of FFR Study design 166 consecutive patients CTCA + ICA + FFR
  • 19. CT- FFR
  • 20. Conclusions 1. FFR-CT, derived from patient-specific CT- based computational models is validated , quality assured, and clinically useful 2. Clinical trials of FFR-CT on-going 3. Novel emerging applications: PCI planner 4. New methods: CT-FFR ( time, ? Accuracy)
  • 21. Thank you for your attention
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