Non-invasive modeling approach uses CT angiograms to aid cardiac treatment

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A modeling approach that uses data from a coronary computed tomography angiogram to create a personalized digital representation of a patient’s coronary arteries is effective in triaging patients for treatment.

Two studies recently support use of the imaging technology to differentiate patients in need of coronary stenting or bypass surgery from those who can be managed with medication alone.

Results from the studies were published in the European Heart Journal and in the Journal of the American College of Cardiology, and were presented during the science session at the European Society of Cardiology conference in Munich.

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The non-invasive technology in the studies looked at the FFRct Analysis of Heartflow, a medical technology company. Data from non-invasive coronary computed tomography angiograms are uploaded from a provider organization’s system to the Heartflow application running in the Amazon Web Services cloud. The vendor’s technology uses deep learning to create a personalized 3D model of the patient’s coronary arteries, then uses algorithms to simulate blood flow and assess the impact of blockages on coronary blood flow.

One study, by ADVANCE Registry, included more than 5,000 patients in the U.S., Japan, Europe and Canada, uses the Heartflow technology to measure the fractional flow reserve computed from noninvasive CT angiography (FFRct). A positive value indicates that a coronary blockage is impeding blood flow, and the Heartflow model then was used to determine optimal treatment. The approach caused physicians to reconsider and change management plans for two-thirds of their patients.

For example, some patients who were originally scheduled to receive a coronary stent or bypass operation were safely able to avoid the procedure and be treated with medications alone, while others who would have received medications were redirected to stenting or bypass surgery.

In the second study, by the Aarhus University Hospital, physicians were able confidently and safely to differentiate higher risk patients who required additional testing, stenting or bypass surgery from patients whose treatment required only medications.

In both studies, coronary narrowing associated with negative FFRct values were predominantly managed with medications alone and were associated with excellent outcomes, similar to those outcomes in patients who had no or minimal narrowing.

“The HeartFlow Analysis is a tool that helps me more effectively develop treatment plans with greater confidence for my CAD patients,” says Timothy Fairbairn, MD, consultant cardiologist at Liverpool Heart and Chest Hospital and lead author of the ADVANCE Registry paper. “Being able to use a non-invasive cardiac test to clearly differentiate which of my patients need invasive procedures or are most at-risk for adverse events is instrumental in my ability to provide them with the best care.”

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