| Summary: |
Cardiovascular diseases are a major cause of mortality and morbidity in developed countries. Coronary atherosclerotic disease (CAD) is a degenerative process that is
characterized by the development of atheromatous plaques on the wall of coronary arteries. Clinical manifestations of CAD range from stable angina, resulting from progressive
plaque growth with partial obstruction of the arterial lumen (stenosis) and consequent limitation of coronary blood flow, to acute coronary syndrome resulting from plaque instability and rupture with subsequent acute thrombosis or atheroembolism. Beyond pharmacological treatment, revascularization therapy can be offered to patients with CAD, resulting in improved prognosis and quality of life. Recently, solid scientific evidence has suggested that the prognostic benefit of coronary revascularization is related to the functional relevance of coronary stenoses that are intervened, that is, the degree of flow limitation capable of creating a deficit in oxygen supply to the myocardium (ischemia). Consequently, functional assessment is often required to determine the potential benefit of future coronary revascularization. In routine clinical practice, two diagnostic strategies are widely used to assess the functional relevance of CAD: the assessment of myocardial perfusion using functional imaging methods, such as scintigraphy or magnetic resonance imaging (MRI) and the invasive assessment of myocardial fractional flow reserve (FFR). Both techniques proved useful in defining a revascularization strategy.
Coronary Computed Tomography Angiography (CTA) is an established non-invasive diagnostic tool for evaluating CAD, with an unprecedented diagnostic accuracy , allowing not only the assessment of anatomic stenosis, but also a detailed characterization of the atherosclerotic plaque. However, CTA can overestimate anatomic stenosis and is limited in that it does not provide information on the hemodynamic relevance of coronary stenosis.  |
Summary
Cardiovascular diseases are a major cause of mortality and morbidity in developed countries. Coronary atherosclerotic disease (CAD) is a degenerative process that is
characterized by the development of atheromatous plaques on the wall of coronary arteries. Clinical manifestations of CAD range from stable angina, resulting from progressive
plaque growth with partial obstruction of the arterial lumen (stenosis) and consequent limitation of coronary blood flow, to acute coronary syndrome resulting from plaque instability and rupture with subsequent acute thrombosis or atheroembolism. Beyond pharmacological treatment, revascularization therapy can be offered to patients with CAD, resulting in improved prognosis and quality of life. Recently, solid scientific evidence has suggested that the prognostic benefit of coronary revascularization is related to the functional relevance of coronary stenoses that are intervened, that is, the degree of flow limitation capable of creating a deficit in oxygen supply to the myocardium (ischemia). Consequently, functional assessment is often required to determine the potential benefit of future coronary revascularization. In routine clinical practice, two diagnostic strategies are widely used to assess the functional relevance of CAD: the assessment of myocardial perfusion using functional imaging methods, such as scintigraphy or magnetic resonance imaging (MRI) and the invasive assessment of myocardial fractional flow reserve (FFR). Both techniques proved useful in defining a revascularization strategy.
Coronary Computed Tomography Angiography (CTA) is an established non-invasive diagnostic tool for evaluating CAD, with an unprecedented diagnostic accuracy , allowing not only the assessment of anatomic stenosis, but also a detailed characterization of the atherosclerotic plaque. However, CTA can overestimate anatomic stenosis and is limited in that it does not provide information on the hemodynamic relevance of coronary stenosis. In recent years, two approaches using cardiac computed tomography (CT) have been developed to address this issue: (1) the non-invasive assessment of FFR derived from classic coronary CTA images (FFR-CT) using computational fluid dynamics (CFD) principles and (2)
Myocardial Perfusion Imaging by CT (CTP), which, like other imaging techniques, assesses the distribution of myocardial blood flow under pharmacological stress, in order to identify
areas of myocardial hypoperfusion (ischemia) supplied by coronary arteries with flow-limiting stenosis. Both strategies have been tested in prospective studies, improving the
diagnostic performance of CTA alone in the detection of functionally relevant CAD, driven by an increase in specificity and positive predictive value. However, few studies have
directly compared the two strategies and no independent study to date has compared the FFR-CT data obtained by the patented method with other technologies for determining
FFR-CT, namely using local computational tools also integrating quantitative dynamic myocardial perfusion data.
The implementation and numerical simulation of blood flow in arteries in the most real physiological conditions and computational methods to extract and analyze data describing myocardial perfusion have been one of the main areas of interest of the PI and the team of engineers / mathematicians involved in this proposal. The clinical research team
involved in this project belongs to one of the main cardiovascular research and development units in the country and works daily in a tertiary hospital, collecting and analyzing data
suitable for this project, using the most modern imaging technologies. In recent years, this team has developed a research line dedicated to the role of advanced cardiac imaging,
namely CT and MRI, in the functional assessment of CAD, supporting clinical decision-making.
Therefore, the main purpose of this project is to develop and validate a computational tool providing an integrated analysis of two CT-derived methods for a comprehensive
characterization of CAD: (1) calculation of the FFR-CT and hemodynamic descriptors; (2) assessment of stress myocardial blood flow through dynamic CTP studies. After validation,
this project will aim to create a software for local use, allowing a comprehensive assessment of CAD in an accessible, fast, reliable and non-invasive way. This clinical solution will
potentially provide a more precise and personalized approach, with predictable gains in diagnostic efficacy and safety, as well as cost reduction in the diagnosis and therapeutic
guidance of patients with CAD. |