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Will Wireless Hemodynamics Replace the Pressure Wire?

Will Wireless Hemodynamics Replace the Pressure Wire?. William F. Fearon , MD Professor of Medicine Director, Interventional Cardiology Stanford University School of Medicine. Affiliation/Financial Relationship Company

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Will Wireless Hemodynamics Replace the Pressure Wire?

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  1. Will Wireless Hemodynamics Replace the Pressure Wire? William F. Fearon, MD Professor of Medicine Director, Interventional Cardiology Stanford University School of Medicine

  2. Affiliation/Financial RelationshipCompany Grant/ Research Support: Abbott, Medtronic, CathWorks, Consulting Fees/Honoraria: Major Stock Shareholder/Equity Interest: Royalty Income: Ownership/Founder: Salary: NIH R61 HL139929-01A1 (PI) Intellectual Property Rights: Other Financial Benefit: Stock Options HeartFlow Disclosure Statement of Financial Interest Within the past 12 months, I or my spouse/partner have had a financial interest /arrangement or affiliation with the organization(s) listed below

  3. CT and Angio-Derived FFR

  4. FFRCT

  5. FFRCT IVUS Invasive Angiography TAG Stress Echo SPECT Coronary CTA CMR FFR (reference standard) FFRCT Nørgaard, et al., Euro Radiology 2015; 25(8): 2282-90. Based on Figure3.

  6. ADVANCE Registry 5,083 patients were found to have CAD on coronary CTA and were asked to develop Rx plan. FFRCT was then performed and incorporated into the plan Patel MR, et al. J Am CollCardiolImg 2019;in press.

  7. ADVANCE Registry 5,083 patients were found to have CAD on coronary CTA and were asked to develop Rx plan. FFRCT was then performed and incorporated into the plan (n=1,530 615 1,000 867 595 130) Patel MR, et al. J Am CollCardiolImg 2019;in press.

  8. FAST-FFR Trial FFRangioAccuracy vs. Standard FFR Trial

  9. FFRangio The 3D engine contains a compensation mechanism which uses all available projections to account for respiratory and cardiac motion and optimizes the 3D reconstruction. Courtesy of CathWorks

  10. FFRangio Automatic stenosis detection by scanning the entire 3D reconstruction Courtesy of CathWorks

  11. FFRangio The coronary arterial network is modeled as an electrical circuit with each segment acting as a resistor. The vessel resistance is estimated based on its length and diameter. Each vessel’s contribution to flow is based on its impact on overall resistance depending on the arrangement. Courtesy of CathWorks

  12. FFRangio Normal maximal flow is estimated based on the volume of coronary vessels and total coronary length. Courtesy of CathWorks

  13. FFRangio FFRangio is then calculated as the ratio of the maximal flow rate in the stenosed artery compared with the flow rate in the absence of the stenosis: FFRangio = QS / QN Courtesy of CathWorks

  14. FFRangio Data FFRangio compared with invasive FFR in 203 lesions (184 patients) Sensitivity, specificity and accuracy of FFRangiowas 88%, 95% and 93% Pellicano, et al. CircCardiovascInterv 2017;10:e005259.

  15. FAST FFR Trial FFRangioAccuracy versus STandardFFR • Rationale: • FFRangiohas not been well validated when performed on-site by independent, local operators blinded to pressure wire-derived FFR and compared with core laboratory analyzed FFR values in a large, prospective, multicenter fashion. Circulation 2019;139:477-84

  16. FFRangio Case Examples FFR=0.68

  17. FFRangio Case Examples FFR=0.87

  18. FAST FFR Trial Patient Characteristics Circulation 2019;139:477-84

  19. FAST FFR Trial Lesion Characteristics Circulation 2019;139:477-84

  20. FAST FFR Trial FFR and FFRangio Results FFRangio was successfully measured in 98.7% of cases Circulation 2019;139:477-84

  21. FAST FFR Trial Co-Primary and Secondary Endpoints Circulation 2019;139:477-84

  22. FAST FFR Trial Features of Discordant Results Circulation 2019;139:477-84

  23. FAST FFR Trial Features of Discordant Results Circulation 2019;139:477-84

  24. FAST FFR Trial Substudy Which correlates better with wire-based FFR: a non-hyperemic pressure ratio (e.g., iFR, dPR, or Pd/Pa) or FFRangio? Johnson, et al. J Am CollCardiol 2019;in press.

  25. FAST FFR Trial Substudy • Physiologically, these results imply that “simulated hyperemia” outperforms “assumed hyperemia” even when disadvantaged by an indirect computation of coronary pressure. • Practically, these findings suggest that centers wishing to avoid invasive FFR for whatever logistical or clinical reasons would be better served by abandoning invasive pressure wires completely and instead employ non-invasive FFR derived from the angiogram. Johnson, et al. J Am CollCardiol 2019;under review

  26. FFR: Measured and Computed • Real world data suggest FFRCT-guided management is safe and predictive of events. We await data from randomized trials investigating this further. • Angiography-derived FFR is a promising new technique which correlates well with FFR and may increase FFR-guided revascularization decisions. • With further clinical outcome data, these techniques will likely replace the need for coronary pressure wires in many common situations.

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