Enterprise AI Analysis
An Integrated Pipeline for Coronary Angiography With Automated Lesion Profiling, Virtual Stenting, and 100-Vessel FFR Validation
Authors: Kopanitsa Georgy, Metsker Oleg, Yakovlev Alexey
This analysis distills key insights from cutting-edge research on angiography-derived physiology, highlighting how an integrated AI pipeline can revolutionize coronary artery disease diagnosis and intervention planning.
Executive Impact: Precision, Efficiency, and Predictive Power
AngioAI–QFR offers substantial improvements in diagnostic accuracy and operational efficiency, directly impacting clinical outcomes and workflow optimization.
0.89
FFR Correlation (Strong Agreement)
0.93
Diagnostic Performance (Ischemia Detection)
93%
Fully Automatic Completion Rate
41s
Median Time-to-Result
Deep Analysis & Enterprise Applications
Select a topic to dive deeper, then explore the specific findings from the research, rebuilt as interactive, enterprise-focused modules.
The Challenge of Coronary Artery Disease
Coronary angiography remains the primary diagnostic tool, but its visual assessment of stenosis severity is often inconsistent and poorly correlated with actual blood flow limitation. Traditional wire-based Fractional Flow Reserve (FFR) provides crucial physiological data but is limited by cost, time, and procedural complexity. This research addresses these limitations by developing an integrated, automated pipeline for angiography-derived physiology.
Key Takeaway: Visual assessment is insufficient; advanced, integrated tools are needed to bridge the gap between anatomical imaging and functional significance.
AngioAI–QFR: An End-to-End Deep Learning Pipeline
The AngioAI–QFR pipeline integrates several advanced components to automate lesion profiling, virtual stenting, and QFR computation directly from routine angiograms:
- Deep Learning for Anatomy: Utilizes YOLOv8m for stenosis detection and DeepLabV3+ for lumen segmentation to accurately delineate coronary vessels.
- RFC Profiling: Extracts vessel centerlines and local diameter profiles, then computes a per-millimetre Relative Flow Capacity (RFC) curve and heatmap, visualizing functional capacity along the vessel.
- Angiography-Derived QFR: Couples reconstructed vessel geometry with a 1D hemodynamic model, using contrast transit to estimate flow and calculate QFR.
- Virtual Stenting: Allows simulation of stent implantation with instant recomputation of QFR, enabling pre-procedural planning for optimal physiological gain.
The innovation lies in its seamless integration, from automated image analysis to physiological prediction and virtual intervention planning, all within a near-real-time workflow.
Enterprise Process Flow: AngioAI–QFR Pipeline
Preprocess Image
→
Detect stenosis's area
→
Segment coronary artery
→
Map area and mask
→
Skeletonization
→
Determination of arterial thickness
Robust Performance & High Accuracy
The system was rigorously evaluated in 100 consecutive vessels against invasive FFR as the reference standard.
AUROC 0.93
for FFR ≤ 0.80, indicating excellent discrimination for physiologically significant ischemia.
Key Performance Metrics:
- Agreement with FFR: Strong correlation (r = 0.89), low mean absolute error (MAE 0.045), and root-mean-square error (RMSE 0.069).
- Diagnostic Performance: Sensitivity of 0.88 and specificity of 0.86 at the FFR ≤ 0.80 threshold.
- Computer Vision: Stenosis detection achieved precision 0.966, mAP@50 0.973; lumen segmentation achieved IoU 0.643 and Dice 0.781.
- Workflow Efficiency: 93% fully automatic completion rate with a median time-to-result of 41 seconds, demonstrating compatibility with intraprocedural use.
Performance was consistent across different coronary territories and image quality strata, with predictable degradation in challenging views (e.g., severe overlap), highlighting areas for future refinement.
Transforming Clinical Practice & Future Directions
AngioAI–QFR's integrated approach offers several crucial clinical and technical advantages:
- Enhanced Decision Support: RFC profiling intuitively distinguishes focal from diffuse disease, guiding stent sizing and placement. Virtual stenting predicts larger QFR gains in focal disease (median ΔQFR +0.07) compared to diffuse disease (median ΔQFR +0.03), informing intervention strategies.
- Unified Workflow: The pipeline eliminates the need for separate software modules and manual lesion demarcation, streamlining cath-lab procedures and enabling real-time physiological assessment.
- Wire-Free Physiology: Provides FFR-comparable accuracy without the constraints of pressure wires, making physiological assessment more accessible and systematic.
While this single-center, retrospective study provides strong validation, future multicenter, prospective studies, including post-PCI outcome evaluations, are warranted to solidify its translational feasibility and impact.
| Feature | AngioAI–QFR | Traditional QFR/vFFR/FFRangio Tools |
|---|---|---|
| Workflow Integration | Unified, interactive, end-to-end pipeline (detection, segmentation, RFC, virtual PCI, QFR) | Often separate modules, requiring manual steps or lacking full integration |
| Automation Level | High (93% fully automatic, minor ROI adjustment in 7%) | Can be workflow-intensive, may require manual demarcation/vessel selection |
| Physiological Profiling | Per-millimetre RFC curves and heatmaps, distinguishing focal vs. diffuse disease | Typically provides a single QFR/FFR value, less granular longitudinal insight |
| Virtual PCI Planning | Integrated virtual stenting with instant recomputation of ΔQFR | Capabilities may exist, but often decoupled from automated anatomy analysis |
| Time-to-Result | Near real-time (median 41s) | Variable, often longer due to manual steps and separate tools |
| FFR Agreement (r) | 0.89 | Comparable (e.g., vFFR ~0.89, FFRangio ~0.89) |
| AUROC for Ischemia | 0.93 | Comparable (meta-analyses ~0.89-0.93) |
Case Study Spotlight: Real-time Virtual Stenting
Imagine a scenario in the cath lab where an interventional cardiologist needs to assess the functional impact of a coronary lesion and plan the optimal stent placement. With AngioAI–QFR, the process becomes instantaneous.
1. Automated Analysis: The system automatically detects the lesion and segments the vessel, generating an RFC profile.
2. Focal vs. Diffuse: The RFC curve clearly shows a sharp, focal drop in capacity. This immediately suggests a high likelihood of significant physiological gain from stenting.
3. Virtual Stent Placement: The cardiologist selects a virtual stent length and position directly on the angiogram or RFC curve. The system instantly recomputes the QFR.
4. Predictive Gain: The virtual stent shows a predicted ΔQFR of +0.07, indicating a substantial improvement in flow. This real-time feedback empowers the cardiologist to confirm the optimal intervention strategy, potentially avoiding unnecessary procedures or optimizing stent selection for better patient outcomes.
This integrated, interactive approach eliminates guesswork and brings data-driven precision directly into the interventional workflow.
Calculate Your Potential AI ROI
Estimate the efficiency gains and cost savings your enterprise could achieve by integrating advanced AI solutions.
Estimated Annual Savings
$0
Hours Reclaimed Annually
0
Your AI Implementation Roadmap
A strategic approach to integrating cutting-edge AI for maximum impact and minimal disruption.
Phase 1: Discovery & Strategy
Conduct a comprehensive audit of existing workflows, identify high-impact AI opportunities, and define clear objectives and KPIs. Develop a tailored AI strategy aligned with your enterprise goals.
Phase 2: Pilot & Proof of Concept
Implement a targeted pilot program to validate AI solutions on a small scale. Gather data, refine models, and demonstrate tangible ROI before broader deployment.
Phase 3: Integration & Scaling
Seamlessly integrate AI solutions into your existing IT infrastructure. Scale the deployment across relevant departments, ensuring robust performance and user adoption.
Phase 4: Optimization & Future-Proofing
Continuously monitor AI performance, gather feedback, and iterate for ongoing optimization. Explore new AI advancements to maintain a competitive edge and adapt to evolving needs.
Ready to Transform Your Enterprise with AI?
Schedule a personalized consultation with our AI specialists to discuss your unique challenges and discover how our integrated solutions can drive your business forward.
Ready to Get Started?
Book Your Free Consultation.
Let's Discuss Your AI Strategy!
Lets Discuss Your Needs
Select a Date
Sun
Mon
Tue
Wed
Thu
Fri
Sat