K Number
K213657
Device Name
DEEPVESSEL FFR
Manufacturer
Date Cleared
2022-04-01

(133 days)

Product Code
Regulation Number
870.1415
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It provides DVFFR (a CT-derived FFR measurement) computed from static coronary CTA images using deep learning neural networks that encode imaging, structural, and functional characteristics of coronary arteries through learning. DEEPVESSEL FFR analysis is intended to support the functional evaluation of coronary artery disease. The results of the analysis are provided to support qualified clinicians to aid in the evaluation and assessment of coronary arteries. DEEPVESSEL FFR results are intended to be used by qualified clinicians in conunction with the patient's clinical history, symptoms, and other diagnostic tests, as well as the clinician's professional judgment.
Device Description
DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative and qualitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It estimates FFR values from static coronary CTA images with extracted coronary tree structures using deep learning neural networks. DEEPVESSEL FFR analysis is intended to support the functional evaluation of CAD. The software processes these images semi-automatically, and it generates a 3D model of the coronay artery tree and computes DVFFR (CT-derived FFR) values. Qualified image analysts interact with the software by providing manual edits to the 3D coronary artery tree segmentations when needed, and oversees outputs along the processing steps. DVFFR analysis results are sent electronically to the physicians via a third-party service portal application. DVFFR software is independent of imaging equipment, imaging protocols and equipment vendors; the clinical validation study report includes the specific imaging scanner types and imaging acquisition parameters used in the clinical validation of the product.
More Information

Not Found

Yes
The device description explicitly states that it uses "deep learning neural networks" and "deep learning-based segmentation algorithms" to compute DVFFR values and generate 3D models. These are forms of artificial intelligence and machine learning.

No.
The device is a diagnostic tool intended to support the evaluation of coronary artery disease by providing CT-derived FFR measurements; it does not directly treat or alleviate symptoms of a disease.

Yes

The device is intended to "support the functional evaluation of coronary artery disease" and provide results to "aid in the evaluation and assessment of coronary arteries," which are functions of a diagnostic device.

Yes

The device is explicitly described as "coronary physiological simulation software" and processes previously acquired imaging data. There is no mention of any accompanying hardware component that is part of the device itself.

Based on the provided information, this device is NOT an In Vitro Diagnostic (IVD).

Here's why:

  • IVDs analyze samples taken from the human body. The core function of an IVD is to examine biological specimens like blood, urine, tissue, etc., to provide information about a person's health.
  • This device analyzes images of the human body. DEEPVESSEL FFR processes previously acquired Computed Tomography (CT) DICOM data, which are medical images. It does not interact with or analyze biological samples.

Therefore, while it is a diagnostic medical device, it falls under the category of imaging software or medical image analysis software, not an In Vitro Diagnostic.

No
The letter does not explicitly state that the FDA has reviewed and approved or cleared a PCCP for this specific device. The 'Control Plan Authorized (PCCP)' section states 'Not Found'.

Intended Use / Indications for Use

DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It provides DVFFR (a CT-derived FFR measurement) computed from static coronary CTA images using deep learning neural networks that encode imaging, structural, and functional characteristics of coronary arteries through learning.

DEEPVESSEL FFR analysis is intended to support the functional evaluation of coronary artery disease.

The results of the analysis are provided to support qualified clinicians to aid in the evaluation and assessment of coronary arteries. DEEPVESSEL FFR results are intended to be used by qualified clinicians in conjunction with the patient's clinical history, symptoms, and other diagnostic tests, as well as the clinician's professional judgment.

Product codes

PJA

Device Description

DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative and qualitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It estimates FFR values from static coronary CTA images with extracted coronary tree structures using deep learning neural networks. DEEPVESSEL FFR analysis is intended to support the functional evaluation of CAD.

The software processes these images semi-automatically, and it generates a 3D model of the coronay artery tree and computes DVFFR (CT-derived FFR) values. Qualified image analysts interact with the software by providing manual edits to the 3D coronary artery tree segmentations when needed, and oversees outputs along the processing steps. DVFFR analysis results are sent electronically to the physicians via a third-party service portal application.

DVFFR software is independent of imaging equipment, imaging protocols and equipment vendors; the clinical validation study report includes the specific imaging scanner types and imaging acquisition parameters used in the clinical validation of the product.

Mentions image processing

Yes

Mentions AI, DNN, or ML

Yes

Input Imaging Modality

Computed Tomography DICOM data

Anatomical Site

Coronary arteries

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Qualified clinicians

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies

Software: Software verification and validation activities were performed according to written procedures and FDA Guidance document Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices. Verification and validation testing confirmed that the predefined acceptance criteria have been fulfilled.

Human Factors Evaluations: Two human factors studies were conducted in accordance with FDA's Guidance Applying Human Factors and Usability Engineering to Medical Devices, 2016. The studies evaluated the critical tasks associated with use of the device for both physicians and analysts. The findings from the study demonstrated that all critical tasks were completed without use error or difficulty. These study results concluded that the DEEPVESSEL reports are safe and effective for the physician user group for the intended uses and use environment. Additionally, the analyst user group were able to safety and accurately use the DVFFR software and generate reports.

Reproducibility/Repeatability Evaluations: Reproducibility (R&R) testing was performed on a group of CT scans with diverse disease conditions and image qualities to evaluate the variation of repeated analyses of DEEPVESSEL FFR with different image analysts (reproducibility) at different days with a washout-period in between to avoid memory effects (repeatability). Testing results met the pre-specified variability metric threshold and thus demonstrated acceptable performance.

Clinical Studies: The software was also validated via a multi-national (US and EU), multicenter clinical validation study with intended patient population to ensure the clinical effectiveness. The primary endpoints of the study were per-vessel sensitivity and specificity of DVFFR to detect ischemic condition comparing with invasive FFR measurement. DVFFR analysis was conducted on a total of 244 patients with 311 target vessels from 8 clinical sites (4 from EU and 4 from US).

Key Metrics

Per-vessel:
Sensitivity: 86.9% (80.6%-92.7%)
Specificity: 86.7% (82.0%-91.1%)
Accuracy: 86.8% (83.0%-90.4%)
PPV: 79.4% (71.8%-86.2%)
NPV: 91.9% (87.7%-95.6%)

Patient-level:
Sensitivity: 87.4% (79.4%-93.1%)
Specificity: 83.7% (76.5%-89.4%)
Accuracy: 85.2% (80.2%-89.4%)
PPV: 79.6% (71.0%-86.6%)
NPV: 90.1% (83.6%-94.6%)

Predicate Device(s)

K161772

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 870.1415 Coronary vascular physiologic simulation software device.

(a)
Identification. A coronary vascular physiologic simulation software device is a prescription device that provides simulated functional assessment of blood flow in the coronary vascular system using data extracted from medical device imaging to solve algorithms and yield simulated metrics of physiologic information (e.g., blood flow, coronary flow reserve, fractional flow reserve, myocardial perfusion). A coronary vascular physiologic simulation software device is intended to generate results for use and review by a qualified clinician.(b)
Classification. Class II (special controls). The special controls for this device are:(1) Adequate software verification and validation based on comprehensive hazard analysis, with identification of appropriate mitigations, must be performed, including:
(i) Full characterization of the technical parameters of the software, including:
(A) Any proprietary algorithm(s) used to model the vascular anatomy; and
(B) Adequate description of the expected impact of all applicable image acquisition hardware features and characteristics on performance and any associated minimum specifications;
(ii) Adequate consideration of privacy and security issues in the system design; and
(iii) Adequate mitigation of the impact of failure of any subsystem components (
e.g., signal detection and analysis, data storage, system communications and cybersecurity) with respect to incorrect patient reports and operator failures.(2) Adequate non-clinical performance testing must be provided to demonstrate the validity of computational modeling methods for flow measurement; and
(3) Clinical data supporting the proposed intended use must be provided, including the following:
(i) Output measure(s) must be compared to a clinically acceptable method and must adequately represent the simulated measure(s) the device provides in an accurate and reproducible manner;
(ii) Clinical utility of the device measurement accuracy must be demonstrated by comparison to that of other available diagnostic tests (
e.g., from literature analysis);(iii) Statistical performance of the device within clinical risk strata (
e.g., age, relevant comorbidities, disease stability) must be reported;(iv) The dataset must be adequately representative of the intended use population for the device (
e.g., patients, range of vessel sizes, imaging device models). Any selection criteria or limitations of the samples must be fully described and justified;(v) Statistical methods must consider the predefined endpoints:
(A) Estimates of probabilities of incorrect results must be provided for each endpoint,
(B) Where multiple samples from the same patient are used, statistical analysis must not assume statistical independence without adequate justification, and
(C) The report must provide appropriate confidence intervals for each performance metric;
(vi) Sensitivity and specificity must be characterized across the range of available measurements;
(vii) Agreement of the simulated measure(s) with clinically acceptable measure(s) must be assessed across the full range of measurements;
(viii) Comparison of the measurement performance must be provided across the range of intended image acquisition hardware; and
(ix) If the device uses a cutoff threshold or operates across a spectrum of disease, it must be established prior to validation, and it must be justified as to how it was determined and clinically validated;
(4) Adequate validation must be performed and controls implemented to characterize and ensure consistency (
i.e., repeatability and reproducibility) of measurement outputs:(i) Acceptable incoming image quality control measures and the resulting image rejection rate for the clinical data must be specified, and
(ii) Data must be provided within the clinical validation study or using equivalent datasets demonstrating the consistency (
i.e., repeatability and reproducibility) of the output that is representative of the range of data quality likely to be encountered in the intended use population and relevant use conditions in the intended use environment;(A) Testing must be performed using multiple operators meeting planned qualification criteria and using the procedure that will be implemented in the production use of the device, and
(B) The factors (
e.g., medical imaging dataset, operator) must be identified regarding which were held constant and which were varied during the evaluation, and a description must be provided for the computations and statistical analyses used to evaluate the data;(5) Human factors evaluation and validation must be provided to demonstrate adequate performance of the user interface to allow for users to accurately measure intended parameters, particularly where parameter settings that have impact on measurements require significant user intervention; and
(6) Device labeling must be provided that adequately describes the following:
(i) The device's intended use, including the type of imaging data used, what the device measures and outputs to the user, whether the measure is qualitative or quantitative, the clinical indications for which it is to be used, and the specific population for which the device use is intended;
(ii) Appropriate warnings specifying the intended patient population, identifying anatomy and image acquisition factors that may impact measurement results, and providing cautionary guidance for interpretation of the provided measurements;
(iii) Key assumptions made in the calculation and determination of simulated measurements;
(iv) The measurement performance of the device for all presented parameters, with appropriate confidence intervals, and the supporting evidence for this performance. Per-vessel clinical performance, including where applicable localized performance according to vessel and segment, must be included as well as a characterization of the measurement error across the expected range of measurement for key parameters based on the clinical data;
(v) A detailed description of the patients studied in the clinical validation (
e.g., age, gender, race or ethnicity, clinical stability, current treatment regimen) as well as procedural details of the clinical study (e.g., scanner representation, calcium scores, use of beta-blockers or nitrates); and(vi) Where significant human interface is necessary for accurate analysis, adequately detailed description of the analysis procedure using the device and any data features that could affect accuracy of results.

0

Image /page/0/Picture/0 description: The image shows the logo for the U.S. Food & Drug Administration (FDA). The logo consists of two parts: the Department of Health & Human Services seal on the left and the FDA acronym followed by the full name of the agency on the right. The FDA part of the logo is in blue, with the acronym in a solid blue square and the agency name in a lighter blue. The text reads "FDA U.S. FOOD & DRUG ADMINISTRATION".

April 1, 2022

KeyaMed NA Inc. % Kelliann Payne Partner Hogan Lovells US LLP 1735 Market Street, Floor 23 Philladelphia, Pennsylvania 19103

Re: K213657

Trade/Device Name: DEEPVESSEL FFR Regulation Number: 21 CFR 870.1415 Regulation Name: Coronary Vascular Physiologic Simulation Software Device Regulatory Class: Class II Product Code: PJA Dated: March 1, 2022 Received: March 1, 2022

Dear Kelliann Payne:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. Although this letter refers to your product as a device, please be aware that some cleared products may instead be combination products. The 510(k) Premarket Notification Database located at https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfpmn/pmn.cfm identifies combination product submissions. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's

1

requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting of medical device-related adverse events) (21 CFR 803) for devices or postmarketing safety reporting (21 CFR 4, Subpart B) for combination products (see https://www.fda.gov/combination-products/guidance-regulatory-information/postmarketing-safety-reportingcombination-products); good manufacturing practice requirements as set forth in the quality systems (OS) regulation (21 CFR Part 820) for devices or current good manufacturing practices (21 CFR 4, Subpart A) for combination products; and, if applicable, the electronic product radiation control provisions (Sections 531-

542 of the Act); 21 CFR 1000-1050.

Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21 CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to https://www.fda.gov/medical-device-safety/medical-device-reportingmdr-how-report-medical-device-problems.

For comprehensive regulatory information about mediation-emitting products, including information about labeling regulations, please see Device Advice (https://www.fda.gov/medicaldevices/device-advice-comprehensive-regulatory-assistance) and CDRH Learn (https://www.fda.gov/training-and-continuing-education/cdrh-learn). Additionally, you may contact the Division of Industry and Consumer Education (DICE) to ask a question about a specific regulatory topic. See the DICE website (https://www.fda.gov/medical-device-advice-comprehensive-regulatoryassistance/contact-us-division-industry-and-consumer-education-dice) for more information or contact DICE by email (DICE@fda.hhs.gov) or phone (1-800-638-2041 or 301-796-7100).

Sincerely,

LCDR Stephen Browning Assistant Director Division of Cardiac Electrophysiology, Diagnostics and Monitoring Devices Office of Cardiovascular Devices Office of Product Evaluation and Quality Center for Devices and Radiological Health

Enclosure

2

510(k) Number (if known)

K213657

Device Name

DEEPVESSEL FFR

Indications for Use (Describe)

DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It provides DVFFR (a CT-derived FFR measurement) computed from static coronary CTA images using deep learning neural networks that encode imaging, structural, and functional characteristics of coronary arteries through learning.

DEEPVESSEL FFR analysis is intended to support the functional evaluation of coronary artery disease.

The results of the analysis are provided to support qualified clinicians to aid in the evaluation and assessment of coronary arteries. DEEPVESSEL FFR results are intended to be used by qualified clinicians in conunction with the patient's clinical history, symptoms, and other diagnostic tests, as well as the clinician's professional judgment.

Type of Use (Select one or both, as applicable)

7 Prescription Use (Part 21 CFR 801 Subpart D)

[ Over-The-Counter Use (21 CFR 801 Subpart C)

CONTINUE ON A SEPARATE PAGE IF NEEDED.

This section applies only to requirements of the Paperwork Reduction Act of 1995.

DO NOT SEND YOUR COMPLETED FORM TO THE PRA STAFF EMAIL ADDRESS BELOW.

The burden time for this collection of information is estimated to average 79 hours per response, including the time to review instructions, search existing data sources, gather and maintain the data needed and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this burden, to:

Department of Health and Human Services Food and Drug Administration Office of Chief Information Officer Paperwork Reduction Act (PRA) Staff PRAStaff(@fda.hhs.gov

"An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB number."

3

510(k) SUMMARY Keya Medical's DEEPVESSEL FFR K213657

Submitter

KeyaMed NA Inc. 107 Spring Street Seattle, WA 98104, USA

Phone: 1 (206) 508-1036 Contact Person: Xiaoxiao Liu Date Prepared: March 25, 2022

Name of Device: DEEPVESSEL FFR

Classification Name: Coronary Vascular Physiologic Simulation Software

Regulatory Class: Class II

Product Code: PJA

Predicate Device: HEARTFLOW, INC.'s FFRcT V2.0 (K161772)

Device Description

DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative and qualitative analysis of previously acquired Computed Tomography DICOM data for clinically stable symptomatic patients with coronary artery disease. It estimates FFR values from static coronary CTA images with extracted coronary tree structures using deep learning neural networks. DEEPVESSEL FFR analysis is intended to support the functional evaluation of CAD.

The software processes these images semi-automatically, and it generates a 3D model of the coronay artery tree and computes DVFFR (CT-derived FFR) values. Qualified image analysts interact with the software by providing manual edits to the 3D coronary artery tree segmentations when needed, and oversees outputs along the processing steps. DVFFR analysis results are sent electronically to the physicians via a third-party service portal application.

DVFFR software is independent of imaging equipment, imaging protocols and equipment vendors; the clinical validation study report includes the specific imaging scanner types and imaging acquisition parameters used in the clinical validation of the product.

Intended Use / Indications for Use

DEEPVESSEL FFR is a coronary physiological simulation software for the clinical quantitative and qualitative analysis of previously acquired Computed Tomography DICOM data for clinically stable

4

symptomatic patients with coronary artery disease. It provides DVFFR (a CT-derived FFR measurement) computed from static coronary CTA images using deep learning neural networks that encode imaging, structural, and functional characteristics of coronary arteries through learning.

DEEPVESSEL FFR analysis is intended to support the functional evaluation of coronary artery disease. The results of the analysis are provided to support qualified clinicians to aid in the evaluation and assessment of coronary arteries. DEEPVESSEL FFR results are intended to be used by qualified clinicians in conjunction with the patient's clinical history, symptoms, and other diagnostic tests, as well as the clinician's professional judgment.

Summary of Technological Characteristics

DEEPVESSEL FFR is a software medical device that is designed to be used by qualified image analysts (trained and certified professionals) to analyze coronary CTA images of clinically stable symptomatic patients with CAD. It calculates CT-derived FFR values from static coronary CTA images using deep learning neural networks. DEEPVESSEL FFR analysis is intended to support the functional evaluation for clinical stable CAD patients.

The software generates the DVFFR analysis results in two main steps. The first step generates a 3D coronary artery tree model from the CTA image automatically using deep learning-based segmentation algorithms. Manual corrections of the segmentation results are allowed when necessary to confirm the accuracy of the 3D coronary artery tree segmentation. In the second step, the deep learning framework consists of a multi-layer perceptron network (MLP) and a bidirectional multi-layer recursive neural network (BRNN), which utilize the segmentation results and the CTA image, to estimate semi-continuous FFR values along the coronary artery centerlines. The output of the analysis is a PDF report with detailed DVFFR assessment and branch visualizations, along with a 3D DVFFR tree model where the DVFFR values are mapped on top of the surface model.

DEEPVESSEL FFR and the predicate device have similar technological characteristics, utilizing computational models to generate CT-derived FFR value for interpretation.

5

Subject DevicePredicate Device
DEEPVESSEL FFR 1.0HeartFlow FFRCT V2.0
(K161772)
ManufacturerKeya MedicalHeartFlow, Inc.
IntendedDEEPVESSEL FFR is a coronaryHeartFlow FFRCT is a coronary
Use/Indications forphysiological simulation software forphysiologic simulation software for
usethe clinical quantitative andthe clinical quantitative and
qualitative analysis of previouslyqualitative analysis of previously
acquired Computed Tomographyacquired Computed Tomography
DICOM data for clinically stableDICOM data for clinically stable
symptomatic patients with coronarysymptomatic patients with coronary
artery disease. It provides DVFFR (aartery disease. It provides FFRCT,
CT-derived FFR measurement)a mathematically derived quantity,
computed from static coronary CTAcomputed from simulated
images using deep learning neuralpressure, velocity and blood flow
networks that encode imaging,information obtained from a 3D
structural, and functionalcomputer model generated from
characteristics of coronary arteriesstatic coronary CT images. FFRCT
through learning.analysis is intended to support the
functional evaluation of coronary
DEEPVESSEL FFR analysis isartery disease.
intended to support the functional
evaluation of coronary arteryThe results of this analysis are
disease.provided to support qualified
The results of the analysis areclinicians to aid in the evaluation
provided to support qualifiedand assessment of coronary
clinicians to aid in the evaluation andarteries. The results of HeartFlow
assessment of coronary arteries.FFRCT are intended to be used by
DEEPVESSEL FFR results arequalified clinicians in conjunction
intended to be used by qualifiedwith the patient's clinical history,
clinicians in conjunction with the withsymptoms, and other diagnostic
the patient's clinical history,tests, as well as the clinician's
symptoms, and other diagnosticprofessional judgment.
tests, as well as the clinician's
professional judgment.
Intended End UserCliniciansClinicians
Clinical ConditionCoronary Artery DiseaseCoronary Artery Disease
InputCoronary CTA DICOM image dataCoronary CTA DICOM image data
Output3D Model & Analysis Report3D Model & Analysis Report

Table 1. Key Feature Comparison

6

Performance Data

The following testing have been conducted to demonstrate the substantial equivalence:

Software: Software verification and validation activities were performed according to written procedures and FDA Guidance document Guidance for the Content of Premarket Submissions for Software Contained in Medical Devices. Verification and validation testing confirmed that the predefined acceptance criteria have been fulfilled.

Human Factors Evaluations: Two human factors studies were conducted in accordance with FDA's Guidance Applying Human Factors and Usability Engineering to Medical Devices, 2016. The studies evaluated the critical tasks associated with use of the device for both physicians and analysts. The findings from the study demonstrated that all critical tasks were completed without use error or difficulty. These study results concluded that the DEEPVESSEL reports are safe and effective for the physician user group for the intended uses and use environment. Additionally, the analyst user group were able to safety and accurately use the DVFFR software and generate reports.

Reproducibility/Repeatability Evaluations: Reproducibility (R&R) testing was performed on a group of CT scans with diverse disease conditions and image qualities to evaluate the variation of repeated analyses of DEEPVESSEL FFR with different image analysts (reproducibility) at different days with a washout-period in between to avoid memory effects (repeatability). Testing results met the pre-specified variability metric threshold and thus demonstrated acceptable performance.

Clinical Studies: The software was also validated via a multi-national (US and EU), multicenter clinical validation study with intended patient population to ensure the clinical effectiveness. The primary endpoints of the study were per-vessel sensitivity and specificity of DVFFR to detect ischemic condition comparing with invasive FFR measurement. DVFFR analysis was conducted on a total of 244 patients with 311 target vessels from 8 clinical sites (4 from EU and 4 from US).

At the vessel level, the observed sensitivity of DVFFR was 86.9% with a two-sided lower bound 95% CI of 80.6%, and the observed specificity of DVFFR was 86.7% with a two-sided lower bound 95% Cl of 82.0%. Both 95% Cl lower bounds for sensitivity and specificity exceeded the performance target of 75% and 70%, respectively, as shown in Table 1.

| | Estimate, %
(two-sided 95% CI) | Lower Bound of the
two-sided 95% CI | Target Rate | Met/Not Met |
|---------------------------------------------------|-----------------------------------|----------------------------------------|-------------|-------------|
| Sensitivity | 86.9%
(80.6%-92.7%) | 80.6% | 75% | Met |
| Specificity | 86.7%
(82.0%-91.1%) | 82.0% | 70% | Met |
| Positive: measured or estimated FFR values ≤ 0.80 | | | | |

Table 1. Per-vessel sensitivity and specificity of DVFFR

The observed diagnostic accuracy, PPV (positive predictive value) and NPV (negative predictive value) of DVFFR were 86.8% (95% Cl: 83.0%-90.4%), 79.4% (95% Cl: 71.8%-86.2%) and 91.9% (95% CI: 87.7%–95.6%), respectively. The results are summarized in Table 2.

7

| | Accuracy
(two-sided 95% CI) | PPV
(two-sided 95% CI) | NPV
(two-sided 95% CI) |
|-------|--------------------------------|---------------------------|---------------------------|
| DVFFR | 86.8%
(83.0%-90.4%) | 79.4%
(71.8%-86.2%) | 91.9%
(87.7%-95.6%) |

Table 2. Per-vessel diagnostic accuracy, PPV and NPV of DVFFR

At the patient level, the observed sensitivity, specificity, accuracy, PPV, and NPV were 87.4% (95% Cl: 79.4%-93.1%), 83.7% (95% Cl: 76.5%-89.4%), 85.2% (95% Cl: 80.2%-89.4%), 79.6% (95% Cl: 71.0%-86.6%), and 90.1% (95% Cl: 83.6%-94.6%), respectively, as shown in Table 3.

| | Sensitivity
(95% CI) | Specificity
(95% CI) | Accuracy
(95% CI) | PPV
(95% CI) | NPV
(95% CI) |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------|-------------------------|------------------------|------------------------|------------------------|
| DVFFR | 87.4%
(79.4%–93.1%) | 83.7%
(76.5%–89.4%) | 85.2%
(80.2%–89.4%) | 79.6%
(71.0%–86.6%) | 90.1%
(83.6%–94.6%) |
| At the patient level, if a patient had more than one ischemic lesion, ICA-FFR value for this patient would be determined as the minimum ICA-FFR measurement from all the coronary arteries. Similarly, patient-level DVFFR value is the minimum DVFFR measurement from all the vessels measured for the patient. | | | | | |

Table 3. Patient-level diagnostic performance of DVFFR

The study demonstrated that DEEPVESSEL FFR yielded good diagnostic performance and met the pre-specified criteria for study success.

Conclusions

DEEPVESSEL FFR, a coronary physiological simulation software, is substantially equivalent to the predicate device, HeartFlow FFRct V2.0 (K161772). DEEPVESSEL FFR and HeartFlow FFRct V2.0 (K161772) share the same intended use and very similar indications for use, technological characteristics, and principles of operation. The only differences between the subject and predicate devices are the algorithms used to calculate the CT-derived FFR values, and these differences do not raise new questions of safety or effectiveness.