1
|
Wang C, Leng S, Tan RS, Chai P, Fam JM, Teo LLS, Chin CY, Ong CC, Baskaran L, Keng YJF, Low AFH, Chan MYY, Wong ASL, Chua SJT, Wu Q, Tan SY, Lim ST, Zhong L. Coronary CT Angiography-based Morphologic Index for Predicting Hemodynamically Significant Coronary Stenosis. Radiol Cardiothorac Imaging 2023; 5:e230064. [PMID: 38166346 PMCID: PMC11163246 DOI: 10.1148/ryct.230064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/14/2023] [Accepted: 10/25/2023] [Indexed: 01/04/2024]
Abstract
Purpose To develop a new coronary CT angiography (CCTA)-based index, α×LL/MLD4, that considers lesion entrance angle (α) in addition to lesion length (LL) and minimal lumen diameter (MLD) and to evaluate its efficacy in predicting hemodynamically significant coronary stenosis compared with invasive coronary angiography (ICA)-derived fractional flow reserve (FFR). Materials and Methods This prospective study enrolled participants (September 2016-March 2020) from two centers who underwent CCTA followed by ICA (ClinicalTrials.gov identifier: NCT03054324). CCTA images were processed semiautomatically to measure LL, MLD, and α for calculating α×LL/MLD4. Diagnostic performance and accuracy of α×LL/MLD4 and LL/MLD4 in detecting hemodynamically significant coronary stenosis were compared against the reference standard (invasive FFR ≤ 0.80). Results In total, 133 participants (mean age, 63 years ± 9 [SD]; 99 [74%] men) with 210 stenosed coronary arteries were analyzed. Median α×LL/MLD4 was 54.0 degree/mm3 (IQR, 25.3-128.7) in participants with invasive FFR of 0.80 or less and 6.7 degree/mm3 (IQR, 3.3-12.8) in participants with invasive FFR of more than 0.80 (P < .001). The per-vessel accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for discriminating ischemic lesions were 86.2%, 83.1%, 88.4%, 84.1%, and 87.7% for α×LL/MLD4 and 80.5%, 66.3%, 90.9%, 84.3%, and 78.6% for LL/MLD4, respectively. Area under the receiver operating characteristic curve for discriminating hemodynamically significant stenosis was 0.93 for α×LL/MLD4, which was significantly greater than the values of 0.84 for LL/MLD4 and 0.63 for diameter stenosis (both P < .001). Conclusion The new morphologic index, α×LL/MLD4, incorporating lesion entrance angle achieved higher diagnostic performance in detecting hemodynamically significant lesions compared with diameter stenosis and LL/MLD4. Keywords: CT Angiography, Cardiac, Coronary Arteries, Ischemia, Infarction, Technology Assessment Clinical trial registration no. NCT03054324 Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Fairbairn and Nørgaard in this issue.
Collapse
Affiliation(s)
| | | | - Ru-San Tan
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ping Chai
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Jiang Ming Fam
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Lynette Li San Teo
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Chee Yang Chin
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Ching Ching Ong
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Lohendran Baskaran
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Yung Jih Felix Keng
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Adrian Fatt Hoe Low
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Mark Yan-Yee Chan
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Aaron Sung Lung Wong
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Siang Jin Terrance Chua
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Qinghua Wu
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Swee Yaw Tan
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Soo Teik Lim
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| | - Liang Zhong
- From the National Heart Research Institute Singapore, National Heart
Centre Singapore, 5 Hospital Dr, 169609 Singapore (C.W., S.L., R.S.T., J.M.F.,
C.Y.C., L.B., Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); The Second
Affiliated Hospital of Nanchang University, Nanchang, China (C.W., Q.W.);
Duke-NUS Medical School, Singapore (S.L., R.S.T., J.M.F., C.Y.C., L.B.,
Y.J.F.K., A.S.L.W., S.J.T.C., S.Y.T., S.T.L., L.Z.); Department of Cardiology,
National University Heart Centre, Singapore (P.C., A.F.H.L., M.Y.Y.C.); Yong Loo
Lin School of Medicine (P.C., L.L.S.T., C.C.O., Y.J.F.K., A.F.H.L., M.Y.Y.C.)
and Department of Biomedical Engineering (L.Z.), National University of
Singapore, Singapore; and Department of Diagnostic Imaging, National University
Hospital, Singapore (L.L.S.T., C.C.O.)
| |
Collapse
|