Online first
Original Article
Published online: 2023-11-09

open access

Page views 844
Article views/downloads 220
Get Citation

Connect on Social Media

Connect on Social Media

Diagnostic accuracy of a novel optical coherence tomography-based fractional flow reserve algorithm for assessment of coronary stenosis significance

Weili Pan1, Wenjuan Wei2, Yumeng Hu3, Li Feng3, Yongkui Ren1, Xinsheng Li1, Changling Li4, Jun Jiang4, Jianping Xiang3, Xiaochang Leng3, Da Yin15
Pubmed: 37964647


Background: This study aimed to introduce a novel optical coherence tomography-derived fractional flow reserve (FFR) computational approach and assess the diagnostic performance of the algorithm for assessing physiological function. Methods: The fusion of coronary optical coherence tomography and angiography was used to generate a novel FFR algorithm (AccuFFRoct) to evaluate functional ischemia of coronary stenosis. In the current study, a total of 34 consecutive patients were included, and AccuFFRoct was used to calculate the FFR for these patients. With the wire-measured FFR as the reference standard, we evaluated the performance of our approach by accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Per vessel accuracy, sensitivity, specificity, PPV, and NPV for AccuFFRoct in identifying hemodynamically significant coronary stenosis were 93.8%, 94.7%, 92.3%, 94.7%, and 92.3%, respectively, were found. Good correlation (Pearson’s correlation coefficient r = 0.80, p < 0.001) between AccuFFRoct and FFR was observed. The Bland-Altman analysis showed a mean difference value of –0.037 (limits of agreement: –0.189 to 0.115). The area under the receiver-operating characteristic curve (AUC) of AccuFFRoct in identifying physiologically significant stenosis was 0.94, which was higher than the minimum lumen area (MLA, AUC = 0.91) and significantly higher than the diameter stenosis (%DS, AUC = 0.78). Conclusions: This clinical study shows the efficiency and accuracy of AccuFFRoct for clinical implementation when using invasive FFR measurement as a reference. It could provide important insights into coronary imaging superior to current methods based on the degree of coronary artery stenosis.

Article available in PDF format

View PDF Download PDF file


  1. Khera AV, Kathiresan S. Genetics of coronary artery disease: discovery, biology and clinical translation. Nat Rev Genet. 2017; 18(6): 331–344.
  2. Jia H, Dai J, Hou J, et al. Effective anti-thrombotic therapy without stenting: intravascular optical coherence tomography-based management in plaque erosion (the EROSION study). Eur Heart J. 2017; 38(11): 792–800.
  3. Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014; 35(37): 2541–2619.
  4. Jones DA, Rathod KS, Koganti S, et al. Angiography alone versus angiography plus optical coherence tomography to Guide percutaneous coronary intervention: Outcomes from the Pan-London PCI Cohort. JACC Cardiovasc Interv. 2018; 11(14): 1313–1321.
  5. Huang J, Emori H, Ding D, et al. Diagnostic performance of intracoronary optical coherence tomography-based versus angiography-based fractional flow reserve for the evaluation of coronary lesions. EuroIntervention. 2020; 16(7): 568–576.
  6. Lee KE, Lee SHo, Shin ES, et al. A vessel length-based method to compute coronary fractional flow reserve from optical coherence tomography images. Biomed Eng Online. 2017; 16(1): 83.
  7. Yu W, Huang J, Jia D, et al. Diagnostic accuracy of intracoronary optical coherence tomography-derived fractional flow reserve for assessment of coronary stenosis severity. EuroIntervention. 2019; 15(2): 189–197.
  8. Dijkstra EW. A note on two problems in connexion with graphs. Numerische Mathematik. 1959; 1(1): 269–271.
  9. van der Zwet PM, Reiber JH. A new approach for the quantification of complex lesion morphology: the gradient field transform; basic principles and validation results. J Am Coll Cardiol. 1994; 24(1): 216–224.
  10. Jiang J, Feng Li, Li C, et al. Fractional flow reserve for coronary stenosis assessment derived from fusion of intravascular ultrasound and X-ray angiography. Quant Imaging Med Surg. 2021; 11(11): 4543–4555.
  11. Schafer S, Singh V, Hoffmann K, et al. Planning image-guided endovascular interventions: guidewire simulation using shortest path algorithms. SPIE Proceedings. 2007.
  12. Gibson CM, Cannon CP, Daley WL, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996; 93(5): 879–888.
  13. Tu S, Westra J, Yang J, et al. Diagnostic Accuracy of Fast Computational Approaches to Derive Fractional Flow Reserve From Diagnostic Coronary Angiography: The International Multicenter FAVOR Pilot Study. JACC Cardiovasc Interv. 2016; 9(19): 2024–2035.
  14. Jiang W, Pan Y, Hu Y, et al. Diagnostic accuracy of coronary computed tomography angiography-derived fractional flow reserve. Biomed Eng Online. 2021; 20(1): 77.
  15. Tonino PAL, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009; 360(3): 213–224.
  16. Xaplanteris P, Fournier S, Pijls NHJ, et al. Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med. 2018; 379(3): 250–259.
  17. Toth GG, Johnson NP, Jeremias A, et al. Standardization of Fractional Flow Reserve Measurements. J Am Coll Cardiol. 2016; 68(7): 742–753.
  18. Toth GG, Toth B, Johnson NP, et al. Revascularization decisions in patients with stable angina and intermediate lesions: results of the international survey on interventional strategy. Circ Cardiovasc Interv. 2014; 7(6): 751–759.
  19. Gutiérrez-Chico JL, Chen Y, Yu W, et al. Diagnostic accuracy and reproducibility of optical flow ratio for functional evaluation of coronary stenosis in a prospective series. Cardiol J. 2020; 27(4): 350–361.
  20. Di Mario C, Demola P. Morphology and physiology together: Is optical coherence tomography the one-stop-shop of invasive cardiology? Cardiol J. 2020; 27(4): 345–346.