1
|
Zhu T, Li D, Qiao J, Li Q, Xu Y, Ge B, Xia L. Accuracy of subtraction fractional flow reserve with computed tomography in identifying early revascularization in patients with coronary artery disease. SCAND CARDIOVASC J 2024; 58:2373082. [PMID: 38962961 DOI: 10.1080/14017431.2024.2373082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/22/2024] [Indexed: 07/05/2024]
Abstract
OBJECTIVES The diagnostic performance of fractional flow reserve with computed tomography (FFR-CT) is affected by the presence of calcified plaque. Subtraction can remove the influence of calcification in coronary computed tomography angiography (CCTA) to increase confidence in the diagnosis of coronary artery stenosis. Our purpose is to investigate the accuracy of post-subtraction FFR-CT in predicting early revascularization. DESIGN Based on CCTA data of 237 vessels from 79 patients with coronary artery disease, subtraction CCTA images were obtained at a local post-processing workstation, and the conventional and post-subtraction FFR-CT measurements and the difference in proximal and distal FFR-CT values of the narrowest segment of the vessel (ΔFFR-CT) were analyzed for their accuracy in predicting early coronary artery hemodynamic reconstruction. RESULTS With FFR-CT ≤ 0.8 as the criterion, the accuracy of conventional and post-subtraction FFR-CT measurements in predicting early revascularization was 73.4% and 77.2% at the patient level, and 64.6% and 72.2% at the vessel level, respectively. The specificity of post-subtraction FFR-CT measurements was significantly higher than that of conventional FFR-CT at both the patient and vessel levels (P of 0.013 and 0.015, respectively). At the vessel level, the area under the curve of receiver operating characteristic was 0.712 and 0.797 for conventional and post-subtraction ΔFFR-CT, respectively, showing a difference (P = 0.047), with optimal cutoff values of 0.07 and 0.11, respectively. CONCLUSION The post-subtraction FFR-CT measurements enhance the specificity in predicting early revascularization. The post-subtraction ΔFFR-CT value of the stenosis segment > 0.11 may be an important indicator for early revascularization.
Collapse
Affiliation(s)
- Tingting Zhu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Defu Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Radiology, Fuyong People's Hospital of Shenzhen Baoan, Shenzhen, China
| | - Jinhan Qiao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Qian Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinghao Xu
- Canon Medical Systems (China) Co. LTD, Beijing, China
| | - Bing Ge
- Canon Medical Systems (China) Co. LTD, Beijing, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
2
|
Li N, Dong X, Zhu C, Shi Z, Pan H, Wang S, Chen Y, Wang W, Zhang T. Association study of NAFLD with pericoronary adipose tissue and pericardial adipose tissue: Diagnosis of stable CAD patients with NAFLD based on radiomic features. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00246-1. [PMID: 39107221 DOI: 10.1016/j.numecd.2024.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/06/2024] [Accepted: 06/29/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND AND AIM Nonalcoholic fatty liver disease (NAFLD) is prone to complicated cardiovascular disease, and we aimed to identify patients with NAFLD who are prone to developing stable coronary artery disease (CAD). METHODS AND RESULTS We retrospectively recruited adults who underwent coronary computed tomography angiography (CTA). A total of 127 NAFLD patients and 127 non-NAFLD patients were included in this study. Clinical features and imaging parameters were analysed, mainly including pericardial adipose tissue (PAT), pericoronary adipose tissue (PCAT), and radiomic features of 6792 PCATs. The inflammatory associations of NAFLD patients with PAT and PCAT were analysed. Clinical features (model 1), CTA parameters (model 2), the radscore (model 3), and a composite model (model 4) were constructed to identify patients with NAFLD with stable CAD. The presence of NAFLD resulted in a greater inflammatory involvement in all three coronary arteries (all P < 0.01) and was associated with increased PAT volume (r = 0.178**, P < 0.05). In the presence of NAFLD, the mean CT value of the PAT was significantly correlated with the fat attenuation index (FAI) in all three vessels and had the strongest correlation with the RCA FAI (r = 0.55, p < 0.001). A total of 9 radiomic features were screened by LASSO regression to calculate radiomic scores. In the model comparison, model 4 had the best performance of all models (AUC 0.914 [0.863-0.965]) and the highest overall diagnostic value of the model (sensitivity: 0.814, specificity: 0.941). CONCLUSIONS NAFLD correlates with PAT volume and PCAT inflammation. Furthermore, combining clinical features, CTA parameters, and radiomic scores can improve the efficiency of early diagnosis of stable CAD in patients with NAFLD.
Collapse
Affiliation(s)
- Na Li
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, CN, China.
| | - Xiaolin Dong
- Department of Radiology, Qilu Hospital of Shandong University Qingdao Branch, Jinan, CN, China
| | - Chentao Zhu
- Department of Radiology, Huzhou Central Hospital, Huzhou, CN, China
| | - Zhenzhou Shi
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, CN, China
| | - Hong Pan
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, CN, China
| | - Shuting Wang
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, CN, China
| | - Yue Chen
- The MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, CN, China
| | - Wei Wang
- The MRI Room, First Affiliated Hospital of Harbin Medical University, Harbin, CN, China.
| | - Tong Zhang
- Department of Radiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, CN, China.
| |
Collapse
|
3
|
Long Y, Guo R, Jin K, An J, Fu P, Lei J, Ma J. Analysis of the perivascular fat attenuation index and quantitative plaque parameters in relation to haemodynamically impaired myocardial ischaemia. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1455-1463. [PMID: 38761288 DOI: 10.1007/s10554-024-03122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/23/2024] [Indexed: 05/20/2024]
Abstract
To investigate the correlation between quantitative plaque parameters, the perivascular fat attenuation index, and myocardial ischaemia caused by haemodynamic impairment. Patients with stable angina who had invasive flow reserve fraction (FFR) assessment and coronary artery computed tomography (CT) angiography were retrospectively enrolled. A total of 138 patients were included in this study, which were categorized into the FFR < 0.75 group (n = 43), 0.75 ≤ FFR ≤ 0.8 group (n = 37), and FFR > 0.8 group (n = 58), depending on the range of FFR values. The perivascular FAI and CTA-derived parameters, including plaque length (PL), total plaque volume (TPV), minimum lumen area (MLA), and narrowest degree (ND), were recorded for the lesions. An FFR < 0.75 was defined as myocardial-specific ischaemia. The relationships between myocardial ischaemia and parameters such as the PL, TPV, MLA, ND, and FAI were analysed using a logistic regression model and receiver operating characteristic (ROC) curves to compare the diagnostic accuracy of various indicators for myocardial ischaemia. The PL, TPV, ND, and FAI were greater in the FFR < 0.75 group than in the grey area group and the FFR > 0.80 group (all p < 0.05). The MLA in the FFR < 0.75 group was lower than that in the grey area group and the FFR > 0.80 group (both P < 0.05). There were no significant differences in the PL, TPV, or ND between the grey area and the FFR > 0.80 group, but there was a significant difference in the FAI. The coronary artery lesions with FFRs ≤ 0.75 had the greatest FAI values. Multivariate analysis revealed that the perivascular FAI and PL density are significant predictors of myocardial ischaemia. The FAI has some predictive value for myocardial ischaemia (AUC = 0.781). After building a combination model using the FAI and plaque length, the predictive power increased (AUC, 0.781 vs. 0.918), and the change was statistically significant (P < 0.001). The combined model of PL + FAI demonstrated great diagnostic efficacy in identifying myocardial ischaemia caused by haemodynamic impairment; the lower the FFR was, the greater the FAI. Thus, the PL + FAI could be a combined measure to securely rule out myocardial ischaemia.
Collapse
Affiliation(s)
- Yangfei Long
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Rui Guo
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Keyu Jin
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - JiaJia An
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Penggang Fu
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Jian Lei
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China
| | - Jing Ma
- Department of Radiology, The Second Affiliated Hospital of Shihezi University, Urumqi, Xinjiang, China.
| |
Collapse
|
4
|
Gupta H, Spanopoulous B, Lubat E, Krinsky G, Rutledge J, Fortier JH, Grau J, Tayal R. Real-world approach to comprehensive artificial intelligence-aided CT evaluation of coronary artery disease in 530 patients: A retrospective study. Heliyon 2023; 9:e19974. [PMID: 37809738 PMCID: PMC10559546 DOI: 10.1016/j.heliyon.2023.e19974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose Recent guidelines provide broader support for the use of less invasive imaging modalities for the evaluation of patients with stable chest pain. Coronary CT angiography (CCTA) uses increasingly sophisticated techniques to improve evaluation of coronary lesions. The purpose of this study is to describe one center's experience implementing AI-assisted advanced imaging techniques to diagnose coronary artery disease. Materials & methods Retrospective study of patients who had AI-assisted CCTA interpretation, including a subgroup who underwent fractional flow reserve CT (FFR-CT) and invasive coronary angiography. Descriptive statistics summarized baseline characteristics and univariate statistics compared findings between groups of patients with and without anatomically and hemodynamically significant lesions based on FFR-CT. For patients who underwent invasive coronary angiography, concordance between CCTA and angiography was evaluated. Results Of 532 included patients, AI-assisted CCTA identified statistically significant difference in calcification scores, plaque types and total plaque volume between lesions <50% and ≥50% stenosis. CCTA results were mostly concordant with invasive coronary angiography. Importantly, we identified a subset of patients with less than 50% anatomical stenosis that demonstrated physiologically significant stenosis on FFR-CT and invasive coronary angiography. Conclusions AI-assisted CCTA and other advanced techniques are a tool to support high quality diagnostic assessment of coronary lesions in a clinical environment. Combined CCTA with FFRCT in mild to moderate coronary stenosis identifies patients with hemodynamically significant stenosis even when quantitative stenosis is <50%. Implementation of AI-assisted coronary CT angiography is feasible in a community hospital setting, but these technologies do not replace the need for expert review and clinical correlation.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Juan Grau
- The Valley Hospital, Ridgewood, NJ, USA
- The University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | |
Collapse
|
5
|
Liu Z, Ding Y, Dou G, Wang X, Shan D, He B, Jing J, Li T, Chen Y, Yang J. Global trans-lesional computed tomography-derived fractional flow reserve gradient is associated with clinical outcomes in diabetic patients with non-obstructive coronary artery disease. Cardiovasc Diabetol 2023; 22:186. [PMID: 37496009 PMCID: PMC10373274 DOI: 10.1186/s12933-023-01901-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/23/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (CT-FFR) enables physiological assessment and risk stratification, which is of significance in diabetic patients with nonobstructive coronary artery disease (CAD). We aim to evaluate prognostic value of the global trans-lesional CT-FFR gradient (GΔCT-FFR), a novel metric, in patients with diabetes without flow-limiting stenosis. METHODS Patients with diabetes suspected of having CAD were prospectively enrolled. GΔCT-FFR was calculated as the sum of trans-lesional CT-FFR gradient in all epicardial vessels greater than 2 mm. Patients were stratified into low-gradient without flow-limiting group (CT-FFR > 0.75 and GΔCT-FFR < 0.20), high-gradient without flow-limiting group (CT-FFR > 0.75 and GΔCT-FFR ≥ 0.20), and flow-limiting group (CT-FFR ≤ 0.75). Discriminant ability for major adverse cardiovascular events (MACE) prediction was compared among 4 models [model 1: Framingham risk score; model 2: model 1 + Leiden score; model 3: model 2 + high-risk plaques (HRP); model 4: model 3 + GΔCT-FFR] to determine incremental prognostic value of GΔCT-FFR. RESULTS Of 1215 patients (60.1 ± 10.3 years, 53.7% male), 11.3% suffered from MACE after a median follow-up of 57.3 months. GΔCT-FFR (HR: 2.88, 95% CI 1.76-4.70, P < 0.001) remained independent risk factors of MACE in multivariable analysis. Compared with the low-gradient without flow-limiting group, the high-gradient without flow-limiting group (HR: 2.86, 95% CI 1.75-4.68, P < 0.001) was associated with higher risk of MACE. Among the 4 risk models, model 4, which included GΔCT-FFR, showed the highest C-statistics (C-statistics: 0.75, P = 0.002) as well as a significant net reclassification improvement (NRI) beyond model 3 (NRI: 0.605, P < 0.001). CONCLUSIONS In diabetic patients with non-obstructive CAD, GΔCT-FFR was associated with clinical outcomes at 5 year follow-up, which illuminates a novel and feasible approach to improved risk stratification for a global hemodynamic assessment of coronary artery in diabetic patients.
Collapse
Affiliation(s)
- Zinuan Liu
- Medical School of Chinese PLA, Beijing, China
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Yipu Ding
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
- School of Medicine, Nankai University, Tianjin, China
| | - Guanhua Dou
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xi Wang
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Dongkai Shan
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Bai He
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Jing Jing
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China
| | - Tao Li
- Department of Radiology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China.
| | - Junjie Yang
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, #6 FuCheng Road, Haidian District, Beijing, China.
| |
Collapse
|
6
|
Takagi H, Ihdayhid AR, Leipsic JA. Integration of fractional flow reserve derived from CT into clinical practice. J Cardiol 2023; 81:577-585. [PMID: 36805489 DOI: 10.1016/j.jjcc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 02/21/2023]
Abstract
Fractional flow reserve (FFR) is currently considered as the gold standard for revascularization decision-making in patients with stable coronary artery disease (CAD). The application of computational fluid dynamics to coronary computed tomography (CT) angiography (CCTA) enables calculation of FFR without additional testing, radiation exposure, contrast medium injection, and hyperemia (FFRCT). Although multiple diagnostic and clinical studies have enriched the scientific evidence, it is still challenging to integrate FFRCT into clinical practice. Both meticulous scientific backgrounds and precise anatomical data derived from CCTA are fundamental for FFRCT computation, and there are numerous factors impacting on FFRCT calculation and interpretation: coronary artery stenosis, calcium, atherosclerosis, luminal volume, and left ventricular myocardial mass. Further, there is a gap that clinicians using FFRCT need to recognize in interpretation of FFRCT results between diagnostic studies and clinical studies. In this review, we summarize multiple evidence related to FFRCT computation and interpretation to refine the FFRCT strategy in patients with stable CAD.
Collapse
Affiliation(s)
- Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Miyagi, Japan.
| | - Abdul Rahman Ihdayhid
- Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Curtin University, Perth, Australia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
7
|
Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. Int J Cardiol 2022; 355:59-64. [DOI: 10.1016/j.ijcard.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/27/2022] [Accepted: 03/07/2022] [Indexed: 12/13/2022]
|
8
|
Takagi H, Leipsic JA, McNamara N, Martin I, Fairbairn TA, Akasaka T, Nørgaard BL, Berman DS, Chinnaiyan K, Hurwitz-Koweek LM, Pontone G, Kawasaki T, Rønnow Sand NP, Jensen JM, Amano T, Poon M, Øvrehus KA, Sonck J, Rabbat MG, Mullen S, De Bruyne B, Rogers C, Matsuo H, Bax JJ, Douglas PS, Patel MR, Nieman K, Ihdayhid AR. Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry. J Cardiovasc Comput Tomogr 2022; 16:19-26. [PMID: 34518113 PMCID: PMC9719736 DOI: 10.1016/j.jcct.2021.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/30/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown. OBJECTIVES To investigate the incremental value of ΔFFRCT in predicting early revascularization and improving efficiency of catheter laboratory utilization. MATERIALS Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFRCT was measured 2 cm distal to stenosis. ΔFFRCT was manually measured as the difference of FFRCT across visible stenosis. RESULTS Of 4730 patients (66 ± 10 years; 34% female), 42.7% underwent ICA and 24.7% underwent early revascularization. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase [95% confidence interval], 1.31 [1.26-1.35]; p < 0.001) after adjusting for risk factors, stenosis features, and lesion-specific FFRCT. Among the 3 models (model 1: risk factors + stenosis type and location + CAD-RADS; model 2: model 1 + FFRCT; model 3: model 2 + ΔFFRCT), model 3 improved discrimination compared to model 2 (area under the curve, 0.87 [0.86-0.88] vs 0.85 [0.84-0.86]; p < 0.001), with the greatest incremental value for FFRCT 0.71-0.80. ΔFFRCT of 0.13 was the optimal cut-off as determined by the Youden index. In patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, a diagnostic strategy incorporating ΔFFRCT >0.13, would potentially reduce ICA by 32.2% (1638-1110, p < 0.001) and improve the revascularization to ICA ratio from 65.2% to 73.1%. CONCLUSIONS ΔFFRCT improves the discrimination of patients who underwent early revascularization compared to a standard diagnostic strategy of CCTA with FFRCT, particularly for those with FFRCT 0.71-0.80. ΔFFRCT has the potential to aid decision-making for ICA referral and improve efficiency of catheter laboratory utilization.
Collapse
Affiliation(s)
- Hidenobu Takagi
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Iwate Medical University Hospital, Iwate, Japan; Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan
| | - Jonathon A Leipsic
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
| | - Noah McNamara
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Isabella Martin
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy A Fairbairn
- Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Daniel S Berman
- Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Kavitha Chinnaiyan
- Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA
| | - Lynne M Hurwitz-Koweek
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Niels Peter Rønnow Sand
- Cardiac Research Unit, Institute of Regional Health Research, University Hospital of Southern DK, Esbjerg and University of Southern DK, Denmark
| | - Jesper M Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Michael Poon
- Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA
| | | | - Jeroen Sonck
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Mark G Rabbat
- Division of Cardiology, Loyola University Chicago, Chicago, IL, USA
| | | | - Bernard De Bruyne
- Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, University Hospital of Lausanne, Lausanne, CH, USA
| | | | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Manesh R Patel
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Koen Nieman
- Department of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA
| | - Abdul Rahman Ihdayhid
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia
| |
Collapse
|
9
|
Tsugu T, Tanaka K, Belsack D, Devos H, Nagatomo Y, Michiels V, Argacha JF, Cosyns B, Buls N, De Maeseneer M, De Mey J. Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease. Int J Cardiol 2021; 343:187-193. [PMID: 34454964 DOI: 10.1016/j.ijcard.2021.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Computed-tomography (CT) derived fractional-flow-reserve (FFRCT) gradually may decrease from proximal to distal vessels even without apparent coronary artery disease (CAD). It may be unclear whether the decrease in FFRCT at the distal coronal artery is physiological or due to stenosis. We decided to study predictive factors of an FFRCT decline below the pathological value of 0.80 in no-apparent CAD. METHODS A total of 150 consecutive patients who had both CT angiography coupled to FFRCT analysis and invasive angiogram showing < 20% coronary stenosis were included. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT > 0.80 (n = 317) and FFRCT ≤ 0.80 (n = 114). ΔFFRCT was defined as the change in FFRCT from proximal to distal vessel. Vessel morphology (vessel length and lumen volume) and plaque characteristics [low-attenuation plaque volume, intermediate-attenuation (IAP) plaque volume, and calcified plaque volume] were evaluated. RESULTS FFRCT decreased from proximal to distal for the three major vessels in both FFRCT > 0.80 and FFRCT ≤ 0.80. Compared to FFRCT > 0.80, IAP volume was significantly higher in all three major vessels in FFRCT ≤ 0.80. ΔFFRCT was correlated with vessel length and lumen volume in FFRCT > 0.80, whereas ΔFFRCT was correlated with IAP volume in FFRCT ≤ 0.80. IAP volume above 44.8 mm3 was the strongest predictor of distal FFRCT of ≤ 0.80. CONCLUSIONS The presence of IAP is a major predictor of gradual decrease of FFRCT below 0.80 in no-apparent CAD vessels. Vessel morphology and plaque characteristics should be considered when interpreting FFRCT.
Collapse
Affiliation(s)
- Toshimitsu Tsugu
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hannes Devos
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Yuji Nagatomo
- Department of Cardiology, National Defense Medical College Hospital, Tokorozawa, Japan
| | - Vincent Michiels
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-François Argacha
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| |
Collapse
|
10
|
Otaki Y, Han D, Klein E, Gransar H, Park RH, Tamarappoo B, Hayes SW, Friedman JD, Thomson LEJ, Slomka PJ, Dey D, Cheng V, Miller RJ, Berman DS. Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRct. J Cardiovasc Comput Tomogr 2021; 16:27-33. [PMID: 34246594 DOI: 10.1016/j.jcct.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 05/07/2021] [Accepted: 06/14/2021] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone. METHODS Per-vessel FFRct was computed in 1,395 vessels of 836 patients undergoing CCTA with 25-99% maximal stenosis. By consensus analysis, stenosis severity was graded as 25-49%, 50-69%, 70-89%, and 90-99%. HRPs including low attenuation plaque (LAP), positive remodeling (PR), and spotty calcification (SC) were assessed in lesions with maximal stenosis. Lesion FFRct was measured distal to the lesion with maximal stenosis, and FFRct<0.80 was defined as abnormal. Association of HRP and abnormal lesion FFRct was evaluated by univariable and multivariable logistic regression models. RESULTS The frequency of abnormal lesion FFRct increased with increase of stenosis severity across each stenosis category (25-49%:6%; 50-69%:30%; 70-89%:54%; 90-99%:91%, p < 0.001). Univariable analysis demonstrated that stenosis severity, LAP, and PR were predictive of abnormal lesion FFRct, while SC was not. In multivariable analyses considering stenosis severity, presence of PR, LAP, and PR and/or LAP were independently associated with abnormal FFRct: Odds ratio 1.58, 1.68, and 1.53, respectively (p < 0.02 for all). The presence of PR and/or LAP increased the frequency of abnormal FFRct with mild stenosis (p < 0.05) with a similar trend with 70-89% stenosis. The combination of 2 HRP (LAP and PR) identified more lesions with FFR < 0.80 than only 1 HRP. CONCLUSIONS Semiquantitative visual assessment of high-risk plaque features may improve the selection of studies for FFRct.
Collapse
Affiliation(s)
- Yuka Otaki
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Donghee Han
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Eyal Klein
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Heidi Gransar
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Rebekah H Park
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Sean W Hayes
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - John D Friedman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Louise E J Thomson
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Piotr J Slomka
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Damini Dey
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
| | - Victor Cheng
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Robert Jh Miller
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA; Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Daniel S Berman
- Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
| |
Collapse
|
11
|
Slipczuk L, Castagna F, Schonberger A, Novogrodsky E, Sekerak R, Dey D, Jorde UP, Levsky JM, Garcia MJ. Coronary artery calcification and epicardial adipose tissue as independent predictors of mortality in COVID-19. Int J Cardiovasc Imaging 2021; 37:3093-3100. [PMID: 33978937 PMCID: PMC8113796 DOI: 10.1007/s10554-021-02276-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/03/2021] [Indexed: 12/17/2022]
Abstract
Recent epidemiological studies have demonstrated that common cardiovascular risk factors are strongly associated with adverse outcomes in COVID-19. Coronary artery calcium (CAC) and epicardial fat (EAT) have shown to outperform traditional risk factors in predicting cardiovascular events in the general population. We aim to determine if CAC and EAT determined by Computed Tomographic (CT) scanning can predict all-cause mortality in patients admitted with COVID-19 disease. We performed a retrospective, post-hoc analysis of all patients admitted to Montefiore Medical Center with a confirmed COVID-19 diagnosis from March 1st, 2020 to May 2nd, 2020 who had a non-contrast CT of the chest within 5 years prior to admission. We determined ordinal CAC scores and quantified the epicardial (EAT) and thoracic (TAT) fat volume and examined their relationship with inpatient mortality. A total of 493 patients were analyzed. There were 197 deaths (39.95%). Patients who died during the index admission had higher age (72, [64–80] vs 68, [57–76]; p < 0.001), CAC score (3, [0–6] vs 1, [0–4]; p < 0.001) and EAT (107, [70–152] vs 94, [64–129]; p = 0.023). On a competing risk analysis regression model, CAC ≥ 4 and EAT ≥ median (98 ml) were independent predictors of mortality with increased mortality of 63% (p = 0.003) and 43% (p = 0.032), respectively. As a composite, the group with a combination of CAC ≥ 4 and EAT ≥ 98 ml had the highest mortality. CAC and EAT measured from chest CT are strong independent predictors of inpatient mortality from COVID-19 in this high-risk cohort.
Collapse
Affiliation(s)
- Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Francesco Castagna
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA
| | | | | | | | - Damini Dey
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ulrich P Jorde
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, 111 E 210th, Bronx, NY, 10467, USA.,Albert Einstein College of Medicine, Bronx, NY, USA.,Radiology Division, Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
12
|
Mrgan M, Nørgaard BL, Dey D, Gram J, Olsen MH, Gram J, Sand NPR. Coronary flow impairment in asymptomatic patients with early stage type-2 diabetes: Detection by FFR CT. Diab Vasc Dis Res 2020; 17:1479164120958422. [PMID: 32985257 PMCID: PMC7919222 DOI: 10.1177/1479164120958422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE To determine the occurrence of physiological significant coronary artery disease (CAD) by coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) in asymptomatic patients with a new diagnosis (<1 year) of type-2 diabetes mellitus (T2DM). METHODS FFRCT-analysis was performed from standard acquired coronary CTA data sets. The per-patient minimum distal FFRCT-value (d-FFRCT) in coronary vessels (diameter ⩾1.8 mm) was registered. The threshold for categorizing FFRCT-analysis as abnormal was a d-FFRCT ⩽0.75. Total plaque volume and volumes of calcified plaque, non-calcified plaque, and low-density non-calcified plaque (LD-NCP) were assessed by quantitative plaque analysis. RESULTS Overall, 76 patients; age, mean (SD): 56 (11) years; males, n (%): 49(65), were studied. A total of 57% of patients had plaques. The d-FFRCT was ⩽0.75 in 12 (16%) patients. The d-FFRCT, median (IQR), was 0.84 (0.79-0.87). Median (range) d-FFRCT in patients with d-FFRCT ⩽0.75 was 0.70 (0.6-0.74). Patients with d-FFRCT⩽0.75 versus d-FFRCT >0.75 had numerically higher plaque volumes for all plaques components, although only significant for the LD-NCP component. CONCLUSION Every sixth asymptomatic patient with a new diagnosis of T2DM has hemodynamic significant CAD as evaluated by FFRCT. Flow impairment by FFRCT was associated with coronary plaque characteristics.
Collapse
Affiliation(s)
- Monija Mrgan
- Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark
| | | | - Damini Dey
- Department of Biomedical Sciences
(Biomedical Imaging Research Institute), Cedars-Sinai Medical Center, Los Angeles,
CA, USA
| | - Jørgen Gram
- Unit for Thrombosis Research, University
of Southern Denmark, Odense
- Department of Clinical Biochemistry,
University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Michael Hecht Olsen
- Cardiology Section, Department of
Internal Medicine, Holbæk Hospital, Holbæk, Sjaelland, Denmark
- Centre for Individualized Medicine in
Arterial Diseases (CIMA), University of Southern Denmark, Denmark
| | - Jeppe Gram
- Department of Endocrinology, University
Hospital of Southern Denmark, Esbjerg, Denmark
| | - Niels Peter Rønnow Sand
- Department of Cardiology, University
Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research,
University of Southern Denmark, Denmark
| |
Collapse
|
13
|
Updates on Fractional Flow Reserve Derived by CT (FFRCT). CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
14
|
Heseltine TD, Murray SW, Ruzsics B, Fisher M. Latest Advances in Cardiac CT. Eur Cardiol 2020; 15:1-7. [PMID: 32180833 PMCID: PMC7066830 DOI: 10.15420/ecr.2019.14.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022] Open
Abstract
Recent rapid technological advancements in cardiac CT have improved image quality and reduced radiation exposure to patients. Furthermore, key insights from large cohort trials have helped delineate cardiovascular disease risk as a function of overall coronary plaque burden and the morphological appearance of individual plaques. The advent of CT-derived fractional flow reserve promises to establish an anatomical and functional test within one modality. Recent data examining the short-term impact of CT-derived fractional flow reserve on downstream care and clinical outcomes have been published. In addition, machine learning is a concept that is being increasingly applied to diagnostic medicine. Over the coming decade, machine learning will begin to be integrated into cardiac CT, and will potentially make a tangible difference to how this modality evolves. The authors have performed an extensive literature review and comprehensive analysis of the recent advances in cardiac CT. They review how recent advances currently impact on clinical care and potential future directions for this imaging modality.
Collapse
Affiliation(s)
| | - Scott W Murray
- Royal Liverpool University Hospital, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | | | - Michael Fisher
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
- Institute for Cardiovascular Medicine and Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| |
Collapse
|
15
|
Williams MC, Newby DE, Nicol ED. Coronary atherosclerosis imaging by CT to improve clinical outcomes. J Cardiovasc Comput Tomogr 2019; 13:281-287. [PMID: 30952611 PMCID: PMC6928571 DOI: 10.1016/j.jcct.2019.03.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/13/2019] [Accepted: 03/25/2019] [Indexed: 01/13/2023]
Abstract
Coronary artery disease remains an important cause of morbidity and mortality world-wide. Coronary Computed Tomography Angiography (CCTA) has excellent diagnostic accuracy and the identification and stratification of coronary artery disease is associated with improved prognosis in multiple studies. Recent randomized controlled trials have shown that in patients with stable coronary artery disease, CCTA is associated with improved diagnosis, changes in investigations, changes in medical treatment and appropriate selection for revascularization. Importantly this diagnostic approach reduces the long-term risk of fatal and non-fatal myocardial infarction. The identification of adverse plaques on CCTA is known to be associated with an increased risk of acute coronary syndrome, but does not appear to be predictive of long-term outcomes independent of coronary artery calcium burden. Future research will involve the assessment of outcomes after CCTA in patients with acute chest pain and asymptomatic patients. In addition, more advanced quantification of plaque subtypes, vascular inflammation and coronary flow dynamics may identify further patients at increased risk.
Collapse
Affiliation(s)
- Michelle C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.
| | - David E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - Edward D Nicol
- Royal Brompton and Harefield NHS Foundation Trust Departments of Cardiology and Radiology, London, UK; National Heart and Lung Institute, Faculty of Medicine, Imperial College, London, UK
| |
Collapse
|
16
|
Nozue T, Takamura T, Fukui K, Hibi K, Kishi S, Michishita I. Plaque Volume and Morphology are Associated with Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography. J Atheroscler Thromb 2018; 26:697-704. [PMID: 30568077 PMCID: PMC6711840 DOI: 10.5551/jat.47621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Aim: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) accurately diagnoses ischemic lesions of intermediate stenosis severity. However, significant determinants of FFRCT have not been fully evaluated. Methods: This was a sub-analysis of the Treatment of Alogliptin on Coronary Atherosclerosis Evaluated by Computed Tomography-Based Fractional Flow Reserve trial. Thirty-nine diabetic patients (117 vessels) with intermediate coronary artery stenosis [percent diameter stenosis (%DS) <70%] in whom FFRCT was measured were included in this study. CCTA-defined, vessel-based volumetric and morphological characteristics of plaques were examined to determine their ability to predict FFRCT. Results: Patient-based, multivariate linear regression analysis showed that hemoglobinA1c, triglycerides, and the estimated glomerular filtration rate were significant independent factors associated with FFRCT. Vessel-based, univariate linear regression analysis showed that the total atheroma volume (r = -0.233, p=0.01) and the percentage atheroma volume (PAV) (r = −0.284, p=0.002) as well as %DS (r = −0.316, p=0.006) were significant determinants of FFRCT. Among the plaque components, significant negative correlations were observed between FFRCT and low- (r = −0.248, p=0.007) or intermediate-attenuation plaque volume (r = −0.186, p= 0.045), whereas calcified plaque volume was not associated with FFRCT. In the left anterior descending coronary artery (LAD), the plaque volume of each component was associated with FFRCT. Conclusions: Plaque volume, PAV, and %DS were significant determinants of FFRCT. Plaque morphology, particularly in LAD, was associated with FFRCT in diabetic patients with intermediate coronary artery stenosis.
Collapse
Affiliation(s)
- Tsuyoshi Nozue
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital
| | | | - Kazuki Fukui
- Department of Cardiology, Kanagawa Cardiovascular and Respiratory Center
| | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | | | - Ichiro Michishita
- Division of Cardiology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital
| |
Collapse
|
17
|
Al’Aref SJ, Mrsic Z, Feuchtner G, Min JK, Villines TC. The Journal of Cardiovascular Computed Tomography year in review - 2018. J Cardiovasc Comput Tomogr 2018; 12:529-538. [DOI: 10.1016/j.jcct.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 10/18/2018] [Indexed: 12/24/2022]
|