IVUS-FFR Accuracy for Coronary Stenosis

Официальное название

Diagnostic Accuracy of Intravascular Ultrasound-Derived Fractional Flow Reserve for Online Assessment of Functionally Significant Coronary Stenosis: A Multicenter Prospective Study

Обзор

IVUS-FFR Online Accuracy for Coronary Stenosis What is this study testing? This study is testing a new technology called IVUS-FFR , which uses ultrasound imaging inside heart arteries (IVUS) to quickly measure whether a narrowed artery ( coronary stenosis ) is reducing blood flow. Unlike the current standard test (FFR), this new method doesn't require extra wires or medication to work. Why is this important? Many patients with heart artery narrowing need tests to decide if a stent is necessary. Current FFR tests involve inserting a pressure wire and giving medication (like adenosine) that can cause discomfort. IVUS-FFR could provide equally accurate results faster, cheaper, and more comfortably . What happens in the study? If you join: Standard heart artery imaging (angiogram) will be performed. An ultrasound probe (IVUS) will be moved through the artery to create detailed images. The new IVUS-FFR software will analyze these images immediately to estimate blood flow. For comparison, a standard FFR test (with pressure wire and medication) will also be done. All steps use existing approved devices and take \<10 extra minutes. Who can participate? Adults (≥18 years) with: Suspected or known heart artery disease At least one artery narrowing (30%-90% blocked) Excluded: Recent heart attack (\<72 hrs), severe kidney/heart failure, or pregnancy. What are the risks and benefits? Risks: Same as routine heart catheterization (bleeding, infection, artery injury). The IVUS and FFR steps add minimal extra risk. Benefits: No direct benefit, but results may improve future care by reducing need for invasive tests. Study goal: To validate if IVUS-FFR is as accurate as the current FFR standard in 292 patients across multiple hospitals in China. Who is running the study? Led by heart specialists at Fuwai Hospital (Beijing) - China's top cardiovascular center - with ethics committee oversight.

Подробное описание

1. Introduction and Study Rationale This study focuses on developing and validating an innovative technology called IVUS-derived Fractional Flow Reserve (IVUS-FFR), which aims to address limitations in current methods for assessing coronary artery stenosis. Coronary artery disease often requires precise evaluation of blood flow restrictions to determine if interventions like stents are necessary. The gold standard, Fractional Flow Reserve (FFR), involves invasive pressure wires and vasodilator drugs (e.g., adenosine), leading to increased costs, procedural time, and potential complications such as allergic reactions or hemodynamic instability. By contrast, IVUS-FFR integrates intravascular ultrasound imaging with computational fluid dynamics to estimate functional significance without additional devices or medications. This approach could streamline clinical workflows, reduce patient discomfort, and lower healthcare expenses, making it a promising advancement in cardiovascular diagnostics. 2. Primary Research Objectives The core goal is to evaluate the diagnostic accuracy of the IVUS-FFR system in identifying hemodynamically significant coronary stenosis, defined as a reduction in blood flow warranting intervention. Using a prospective, multicenter design, the study directly compares IVUS-FFR against FFR as the reference standard. Secondary objectives include assessing feasibility in real-time catheterization lab settings, establishing standardized operational protocols, and refining the technology for broader clinical adoption. Additionally, the study will contrast IVUS-FFR with quantitative coronary angiography (QCA), an anatomical assessment tool, to demonstrate superior diagnostic performance in detecting functionally relevant lesions. 3. Study Design and Methodology Overview This research employs a prospective, multicenter, self-controlled clinical trial framework. It targets enrollment of 292 adult participants with suspected or confirmed coronary artery disease, specifically those exhibiting at least one visually estimated coronary stenosis between 30% and 90% diameter reduction. Participants undergo sequential assessments: first, standard coronary angiography and IVUS imaging to generate detailed vascular reconstructions; second, immediate online IVUS-FFR analysis using proprietary algorithms; and third, conventional FFR measurement for validation. Blinding protocols ensure objectivity-IVUS-FFR operators are unaware of FFR results during analysis, and an independent core lab processes QCA data. Statistical methods include receiver operating characteristic (ROC) curves to calculate area under the curve (AUC), sensitivity and specificity analyses, and Delong tests for comparing IVUS-FFR and QCA performance. The sample size provides 90% statistical power to detect a target diagnostic accuracy of 83% for IVUS-FFR. 4. Technological Innovations and Workflow Integration The IVUS-FFR system represents a significant leap in computational physiology. It combines high-frequency intravascular ultrasound (40MHz probes) with artificial intelligence-driven segmentation. This involves deep neural networks to automatically delineate vessel structures, such as the lumen and external elastic lamina, enabling precise 3D vascular modeling. Blood flow simulations leverage Murray's law for adaptive hemodynamic calculations, ensuring accurate pressure drop estimations across stenoses. Key innovations include real-time processing capabilities-results are generated within 90 seconds of IVUS data acquisition-and compatibility with existing catheterization lab equipment. This integration minimizes workflow disruptions, adding less than 10 minutes to standard procedures while eliminating the need for pressure wires or vasodilators. 5. Participant Eligibility and Ethical Safeguards Eligible participants are adults aged 18 years or older with coronary artery disease symptoms, such as stable or unstable angina, who are scheduled for diagnostic angiography. Exclusion criteria prioritize safety, excluding individuals with recent myocardial infarction (within 72 hours), severe heart failure, significant kidney impairment, pregnancy, or contraindications to iodinated contrast agents. All participants provide informed consent, and the study adheres to stringent ethical oversight through Fuwai Hospital's institutional review board. Rigorous risk mitigation strategies include protocolized management of potential complications like vessel injury during IVUS catheterization and on-site emergency resources for adenosine-related adverse events. 6. Expected Outcomes and Broader Implications Upon completion, the study aims to validate IVUS-FFR as a non-inferior alternative to FFR, with anticipated diagnostic accuracy exceeding 83%. This could establish new clinical standards, reducing reliance on invasive FFR and cutting procedural costs by approximately $850 per case. Broader impacts include intellectual property development, such as 2-3 national patents for the core algorithms and 1-2 software copyrights. Dissemination will occur through high-impact publications in Q1-ranked journals and presentations at international conferences, potentially influencing future guidelines on coronary revascularization. If successful, IVUS-FFR could extend to peripheral vascular applications, enhancing patient outcomes globally by enabling faster, safer, and more accessible functional assessments.

Вмешательства

• Диагностический тест Ultrasound-Derived Fractional Flow Reserve Computational System
  1. Core Technological Innovation This diagnostic system revolutionizes coronary stenosis assessment by integrating intravascular ultrasound (IVUS) imaging with real-time computational physiology . Its proprietary technology features: AI-driven vessel segmentation : Deep neural networks automatically delineate lumen boundaries and external elastic lamina from IVUS images, enabling millimeter-level precision in 3D coronary reconstruction. Dynamic hemodynamic modeling : Adaptive algorit

Первичные конечные точки

• Diagnostic Accuracy of IVUS-FFR in Identifying Hemodynamically Significant Coronary Stenosis [Срок оценки: Single time point assessment: immediately after IVUS-FFR computation during the index cardiac catheterization procedure.]
• Diagnostic Accuracy of IVUS-FFR in Identifying Hemodynamically Significant Coronary Stenosis [Срок оценки: Single assessment at time of index cardiac catheterization procedure.]

Критерии участия

Inclusion Criteria General Requirements

• 18 years of age Diagnosed with stable/unstable angina or post-acute phase myocardial infarction (>72 hours after onset) Able to comprehend study design and provide written informed consent Angiographic \& IVUS-Specific Requirements
• 1 epicardial coronary artery with 30%-90% visual diameter stenosis Reference vessel diameter ≥2.0 mm at target stenosis site Exclusion Criteria General Exclusions Contraindications to invasive procedures/FFR per operator judgment Acute myocardial infarction within 72 hours Cardiogenic shock or severe heart failure (NYHA class ≥III or LVEF <30%) Severe renal dysfunction (Creatinine >150 μmol/L or eGFR <45 mL/min/1.73m²) Allergy to iodinated contrast media or adenosine Pregnancy/lactation Life expectancy <1 year Concurrent participation in other interventional trials Angiographic \& IVUS-Specific Exclusions Myocardial bridging at target lesion Severely calcified or tortuous vessels precluding safe IVUS Isolated >90% stenosis with TIMI flow grade <3 in major epicardial artery Other conditions deemed unsuitable for IVUS/FFR by investigators

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Не применимо

Модель

Одна группа

Маскирование

Открытое

Основная цель

Лечение

Центры проведения

Китай · 1 центр

• Fuwai hospital — Пекин

Публикации

• Engstrom T, Kelbaek H, Helqvist S, Hofsten DE, Klovgaard L, Holmvang L, Jorgensen E, Pedersen F, Saunamaki K, Clemmensen P, De Backer O, Ravkilde J, Tilsted HH, Villadsen AB, Aaroe J, Jensen SE, Raungaard B, Kober L; DANAMI-3-PRIMULTI Investigators. Complete revascularisation versus treatment of the culprit lesion only in patients with ST-segment elevation myocardial infarction and multivessel dis PMID 26347918
• Smits PC, Abdel-Wahab M, Neumann FJ, Boxma-de Klerk BM, Lunde K, Schotborgh CE, Piroth Z, Horak D, Wlodarczak A, Ong PJ, Hambrecht R, Angeras O, Richardt G, Omerovic E; Compare-Acute Investigators. Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction. N Engl J Med. 2017 Mar 30;376(13):1234-1244. doi: 10.1056/NEJMoa1701067. Epub 2017 Mar 18. PMID 28317428
• Zimmermann FM, Omerovic E, Fournier S, Kelbaek H, Johnson NP, Rothenbuhler M, Xaplanteris P, Abdel-Wahab M, Barbato E, Hofsten DE, Tonino PAL, Boxma-de Klerk BM, Fearon WF, Kober L, Smits PC, De Bruyne B, Pijls NHJ, Juni P, Engstrom T. Fractional flow reserve-guided percutaneous coronary intervention vs. medical therapy for patients with stable coronary lesions: meta-analysis of individual patient PMID 30596995

Идентификаторы

NCT: NCT07446023 · 2024-2463

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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