Comparison of Accuracy of One-Use Methods for Calculating Fractional Flow Reserve by Intravascular Optical Coherence Tomography to That Determined by the Pressure-Wire Method

Although the identification of the hemodynamic significance of coronary lesions becomes important for revascularization strategy, the potential role of 3-dimensional high-resolution intracoronary optical coherence tomography (OCT) for predicting functional significance of coronary lesions remains unclear. We assessed the diagnostic performance of 2 computational approaches for deriving fractional flow reserve (FFR) from intravascular OCT images. We developed 2 methods to derive FFR-OCT by AFD (FFR-OCT AFD ) and FFR-OCT by CFD (FFR-OCT CFD ). Among 217 eligible patients between 2011 and 2014, 104 were included for data analysis (9 for derivation, 95 for validation). Luminal geometries from 3-dimensional OCT were used for both FFR-OCT AFD and FFR-OCT CFD calculations. The analytical fluid dynamics method calculated FFR from the blood flow resistance estimated using Poiseuille's law. For computational fluid dynamics, we numerically solved the Navier–Stokes equation in a steady-state flow with the distal porous media model for the capillary vessels. We examined the diagnostic performance of FFR-OCT AFD and FFR-OCT CFD compared with the pressure-wire measured FFR. The accuracy, sensitivity, specificity, PPV, and NPV were 86%, 65%, 94%, 81%, and 88% for FFR-OCT AFD and 86%, 73%, 91%, 76%, and 90% for FFR-OCT CFD . The area under the curve of the receiver-operating characteristic curve was 0.88 for FFR-OCT AFD and 0.86 for FFR-OCT CFD . FFR-OCT AFD and FFR-OCT CFD showed a strong linear correlation with the measured FFR (r = 0.631; p