1
|
Qiao HY, Wu Y, Li HC, Zhang HY, Wu QH, You QJ, Ma X, Hu SD. Role of Quantitative Plaque Analysis and Fractional Flow Reserve Derived From Coronary Computed Tomography Angiography to Assess Plaque Progression. J Thorac Imaging 2023; 38:186-193. [PMID: 36728026 PMCID: PMC10128899 DOI: 10.1097/rti.0000000000000697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To explore the role of quantitative plaque analysis and fractional flow reserve (CT-FFR) derived from coronary computed angiography (CCTA) in evaluating plaque progression (PP). METHODS A total of 248 consecutive patients who underwent serial CCTA examinations were enrolled. All patients' images were analyzed quantitatively by plaque analysis software. The quantitative analysis indexes included diameter stenosis (%DS), plaque length, plaque volume (PV), calcified PV, noncalcified PV, minimum lumen area (MLA), and remodeling index (RI). PP is defined as PAV (percentage atheroma volume) change rate >1%. CT-FFR analysis was performed using the cFFR software. RESULTS A total of 76 patients (30.6%) and 172 patients (69.4%) were included in the PP group and non-PP group, respectively. Compared with the non-PP group, the PP group showed greater %DS, smaller MLA, larger PV and non-calcified PV, larger RI, and lower CT-FFR on baseline CCTA (all P <0.05). Logistic regression analysis showed that RI≥1.10 (odds ratio [OR]: 2.709, 95% CI: 1.447-5.072), and CT-FFR≤0.85 (OR: 5.079, 95% CI: 2.626-9.283) were independent predictors of PP. The model based on %DS, quantitative plaque features, and CT-FFR (area under the receiver-operating characteristics curve [AUC]=0.80, P <0.001) was significantly better than that based rarely on %DS (AUC=0.61, P =0.007) and that based on %DS and quantitative plaque characteristics (AUC=0.72, P <0.001). CONCLUSIONS Quantitative plaque analysis and CT-FFR are helpful to identify PP. RI and CT-FFR are important predictors of PP. Compared with the prediction model only depending on %DS, plaque quantitative markers and CT-FFR can further improve the predictive performance of PP.
Collapse
Affiliation(s)
| | - Yong Wu
- Departments of Medical Imaging
| | - Hai Cheng Li
- Department of Medical Imaging, Minhe County People’s Hospital, Haidong, Qing hai, China
| | - Hai Yan Zhang
- Department of Medical Imaging, Minhe County People’s Hospital, Haidong, Qing hai, China
| | | | - Qing Jun You
- Thoracic Surgery, Affiliated Hospital of Jiangnan University
| | - Xin Ma
- School of Medicine, Jiangnan University, Wuxi, Jiangsu
| | | |
Collapse
|
2
|
Zhang LJ, Tang C, Xu P, Guo B, Zhou F, Xue Y, Zhang J, Zheng M, Xu L, Hou Y, Lu B, Guo Y, Cheng J, Liang C, Song B, Zhang H, Hong N, Wang P, Chen M, Xu K, Liu S, Jin Z, Lu G. Coronary Computed Tomography Angiography-derived Fractional Flow Reserve: An Expert Consensus Document of Chinese Society of Radiology. J Thorac Imaging 2022; 37:385-400. [PMID: 36162081 DOI: 10.1097/rti.0000000000000679] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Invasive fractional flow reserve (FFR) measured by a pressure wire is a reference standard for evaluating functional stenosis in coronary artery disease. Coronary computed tomography angiography-derived fractional flow reserve (CT-FFR) uses advanced computational analysis methods to noninvasively obtain FFR results from a single conventional coronary computed tomography angiography data to evaluate the hemodynamic significance of coronary artery disease. More and more evidence has found good correlation between the results of noninvasive CT-FFR and invasive FFR. CT-FFR has proven its potential in optimizing patient management, improving risk stratification and prognosis, and reducing total health care costs. However, there is still a lack of standardized interpretation of CT-FFR technology in real-world clinical settings. This expert consensus introduces the principle, workflow, and interpretation of CT-FFR; summarizes the state-of-the-art application of CT-FFR; and provides suggestions and recommendations for the application of CT-FFR with the aim of promoting the standardized application of CT-FFR in clinical practice.
Collapse
Affiliation(s)
- Long Jiang Zhang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Chunxiang Tang
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Pengpeng Xu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Bangjun Guo
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Fan Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Yi Xue
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| | - Jiayin Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, The Fourth Military Medical University-Xi'an
| | - Lei Xu
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University
| | - Bin Lu
- Department of Radiology, State Key Laboratory and National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province
| | - Bin Song
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan Province
| | - Huimao Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital
| | - Peijun Wang
- Department of Radiology, Tongji Hospital of Tongji University School of Medicine
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology
| | - Ke Xu
- Department of Interventional Radiology, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province
| | - Shiyuan Liu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences
| | - Zhengyu Jin
- Department of Medical Imaging and Nuclear Medicine, Changzheng Hospital of Naval Medical University, Shanghai
| | - Guangming Lu
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu Province
| |
Collapse
|
3
|
Fusaro M, Caruso D, Tessarin G, de Santis D, Balestriero G, Bortolanza C, Panvini N, Polidori T, Laghi A, Morana G. Comparison of Triple-Rule-Out Prospectively ECG-triggered Systolic and Diastolic Acquisition Protocol in Patients With Acute Chest Pain. J Thorac Imaging 2022; 37:W72-W77. [PMID: 34534998 DOI: 10.1097/rti.0000000000000620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to compare image quality and coronary interpretability of triple-rule-out systolic and diastolic protocols in patients with acute chest pain. MATERIALS AND METHODS From March 2016 to October 2017 the authors prospectively enrolled patients with undifferentiated acute chest pain, who were at low to intermediate cardiovascular risk. Those with heart rate >75 bpm underwent a systolic prospectively triggered acquisition (systolic triggering [ST]), and in those with ≤75 bpm, end-diastolic triggering (DT) was instead performed. Examinations were evaluated for coronary artery disease, aortic dissection, and pulmonary embolism. Image quality was assessed using a Likert scale. Coronary arteries interpretability was evaluated both on a per-vessel and a per segment basis. The occurrence of major adverse cardiovascular events was investigated. RESULTS The final study population was 189 patients. Fifty-two patients (27.5%) underwent systolic acquisition and 137 (72.5%) underwent diastolic acquisition. No significant differences in overall image quality were observed between DT and ST groups (median score 5 [interquartile ranges 4 to 5] vs. 4 [interquartile ranges 4 to 5], P =0.074). Although both DT and ST protocols showed low percentages of noninterpretable coronary arteries on a per-vessel (1.5% and 6.7%, respectively) and per-segment analysis (1% and 4.7%, respectively), these percentages resulted significantly higher for ST groups ( P <0.001). Obstructive coronary stenosis was observed in 18 patients. Only one case of pulmonary embolism was diagnosed and no cases of aortic dissection were found in our population. No death or major adverse cardiovascular events were observed during follow-up among the 2 groups. CONCLUSIONS Results showed that triple-rule-out computed tomography angiography is a reliable technique in patients with acute chest pain and that an ST acquisition protocol could be considered an alternative acquisition protocol in patients with higher heart rate, reaching a good image quality.
Collapse
Affiliation(s)
- Michele Fusaro
- Department of Radiology, Santa Maria di Ca' Foncello Hospital, Treviso
| | - Damiano Caruso
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Giovanni Tessarin
- Department of Medicine-DIMED, Institute of Radiology, University of Padova, Padua, Italy
| | - Domenico de Santis
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | | | - Carlo Bortolanza
- Department of Radiology, Santa Maria di Ca' Foncello Hospital, Treviso
| | - Nicola Panvini
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Tiziano Polidori
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Andrea Laghi
- Department of Radiological, Oncological and Pathological Science, Sant'Andrea Hospital, "La Sapienza" University of Rome, Rome
| | - Giovanni Morana
- Department of Radiology, Santa Maria di Ca' Foncello Hospital, Treviso
| |
Collapse
|
4
|
Serial Changes in Coronary Plaque Formation Using CT Angiography in Patients Undergoing PCSK9-Inhibitor Therapy With 1-year Follow-up. J Thorac Imaging 2022; 37:285-291. [PMID: 35797638 DOI: 10.1097/rti.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies have shown positive effects of intensive low-density lipoprotein (LDL)-lowering therapy on atheroma volume using invasive intravascular ultrasound. This study describes the changes in coronary plaque composition on coronary computed tomography angiography in patients treated with proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors. MATERIALS AND METHODS In this prospective study, coronary plaques were analyzed using third-generation dual-source computed tomography before and after 1 year of PCSK9-inhibitor treatment. Plaque markers included total plaque volume (TPV), calcified plaque volume (CPV), noncalcified plaque volume (NCPV), lumen volume and vessel volume (VV), minimal luminal area (MLA), minimal lumen diameter (MLD), corrected coronary opacification, eccentricity, remodeling index, and functional plaque parameters. Primary endpoint was defined as change in TPV; the secondary endpoint was TPV or CPV regression or nominal change in plaque parameters. RESULTS We analyzed 74 coronary plaques in 23 patients (60±9 y, 65% male). After 1 year of PCSK9-inhibitor treatment, LDL was reduced from 148 to 66 mg/dL ( P <0.0001). Significant changes were found for VV (196 to 215 mm 3 , P =0.0340), MLA (3.1 to 2.6 mm 2 , P =0.0413), and MLD (1.7 to 1.4 mm, P =0.0048). TPV, CPV, NCPV, lumen volume, and functional plaque parameters did not change significantly ( P >0.05). CONCLUSIONS Coronary artery plaque analysis by coronary computed tomography angiography highlights that LDL lowering therapy affects plaque composition. The primary endpoint of TPV change was not reached; however, VV, MLA, and MLD changed significantly.
Collapse
|
5
|
Tesche C, Giesen A, Korosoglou G. Commentary: Plaque Features and Epicardial Fat Volume for Cardiovascular Risk Assessment—A Key Role With Cardiac Computed Tomography? Front Cardiovasc Med 2022; 9:896321. [PMID: 35571220 PMCID: PMC9099000 DOI: 10.3389/fcvm.2022.896321] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian Tesche
- Department of Cardiology, Clinic Augustinum Munich, Munich, Germany
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States
| | - Alexander Giesen
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany
- Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany
- Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
- *Correspondence: Grigorios Korosoglou
| |
Collapse
|
6
|
Kanda A, Velangi PS, Kenny B, Duval S, Nijjar PS. Interplay of CT Coronary Plaque Characteristics and Ischemia to Predict Adverse Outcomes. Radiol Cardiothorac Imaging 2021; 3:e210189. [PMID: 34934949 DOI: 10.1148/ryct.2021210189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 10/18/2021] [Indexed: 11/11/2022]
Abstract
In 134 patients with stable coronary artery disease, high-risk plaque features at CT and physiologic stenosis were found to act in a synergistic fashion to predict adverse outcomes.
Collapse
Affiliation(s)
- Adinan Kanda
- Department of Medicine (A.K., P.S.V.) and Cardiovascular Division, Department of Medicine (B.K., S.D., P.S.N.), University of Minnesota Medical School, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
| | - Pratik S Velangi
- Department of Medicine (A.K., P.S.V.) and Cardiovascular Division, Department of Medicine (B.K., S.D., P.S.N.), University of Minnesota Medical School, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
| | - Barrett Kenny
- Department of Medicine (A.K., P.S.V.) and Cardiovascular Division, Department of Medicine (B.K., S.D., P.S.N.), University of Minnesota Medical School, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
| | - Sue Duval
- Department of Medicine (A.K., P.S.V.) and Cardiovascular Division, Department of Medicine (B.K., S.D., P.S.N.), University of Minnesota Medical School, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
| | - Prabhjot S Nijjar
- Department of Medicine (A.K., P.S.V.) and Cardiovascular Division, Department of Medicine (B.K., S.D., P.S.N.), University of Minnesota Medical School, 420 Delaware St SE, MMC 508, Minneapolis, MN 55455
| |
Collapse
|
7
|
Maschinelles Lernen schlägt klassische Risikobewertung bei der koronaren Herzkrankheit. ROFO-FORTSCHR RONTG 2021. [DOI: 10.1055/a-1395-2301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|