Georgy Kopanitsa

Georgy Kopanitsa, Oleg Metsker, Alexey Yakovlev

Coronary angiography is the main tool for assessing coronary artery disease, but visual grading of stenosis is variable and only moderately related to ischaemia. Wire based fractional flow reserve (FFR) improves lesion selection but is not used systematically. Angiography derived indices such as quantitative flow ratio (QFR) offer wire free physiology, yet many tools are workflow intensive and separate from automated anatomy analysis and virtual PCI planning. We developed AngioAI-QFR, an end to end angiography only pipeline combining deep learning stenosis detection, lumen segmentation, centreline and diameter extraction, per millimetre Relative Flow Capacity profiling, and virtual stenting with automatic recomputation of angiography derived QFR. The system was evaluated in 100 consecutive vessels with invasive FFR as reference. Primary endpoints were agreement with FFR (correlation, mean absolute error) and diagnostic performance for FFR <= 0.80. On held out frames, stenosis detection achieved precision 0.97 and lumen segmentation Dice 0.78. Across 100 vessels, AngioAI-QFR correlated strongly with FFR (r = 0.89, MAE 0.045). The AUC for detecting FFR <= 0.80 was 0.93, with sensitivity 0.88 and specificity 0.86. The pipeline completed fully automatically in 93 percent of vessels, with median time to result 41 s. RFC profiling distinguished focal from diffuse capacity loss, and virtual stenting predicted larger QFR gain in focal than in diffuse disease. AngioAI-QFR provides a practical, near real time pipeline that unifies computer vision, functional profiling, and virtual PCI with automated angiography derived physiology.

Sergey V. Kovalchuk, Georgy D. Kopanitsa, Ilia V. Derevitskii et al.

The paper presents an approach for building consistent and applicable clinical decision support systems (CDSSs) using a data-driven predictive model aimed at resolving the problem of low applicability and scalability of CDSSs in real-world applications. The approach is based on a threestage application of domain-specific and data-driven supportive procedures that are to be integrated into clinical business processes with higher trust and explainability of the prediction results and recommendations. Within the considered three stages, the regulatory policy, data-driven modes, and interpretation procedures are integrated to enable natural domain-specific interaction with decisionmakers with sequential narrowing of the intelligent decision support focus. The proposed methodology enables a higher level of automation, scalability, and semantic interpretability of CDSSs. The approach was implemented in software solutions and tested within a case study in T2DM prediction, enabling us to improve known clinical scales (such as FINDRISK) while keeping the problem-specific reasoning interface similar to existing applications. Such inheritance, together with the three-staged approach, provide higher compatibility of the solution and leads to trust, valid, and explainable application of data-driven solutions in real-world cases.