Rui Wang1, Stefan Baumann2, U Joseph Schoepf3, Felix G Meinel4, Jeremy D Rier5, Justin Z Morris6, Helge Möllmann7, Christian W Hamm8, Daniel H Steinberg9, Matthias Renker10. 1. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China. Electronic address: rui_wang1979@hotmail.com. 2. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre, Mannheim (UMM), University of Heidelberg, Mannheim, Germany. Electronic address: stefanbaumann@gmx.at. 3. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA. Electronic address: schoepf@musc.edu. 4. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany. Electronic address: felix.meinel@med.uni-muenchen.de. 5. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA. Electronic address: rier@musc.edu. 6. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA. Electronic address: jstn.morris821@gmail.com. 7. Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. Electronic address: h.moellmann@kerckhoff-klinik.de. 8. Department of Medicine I, University Hospital Giessen and Marburg, Giessen, Germany. Electronic address: christian.hamm@innere.med.uni-giessen.de. 9. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA. Electronic address: steinbe@musc.edu. 10. Heart & Vascular Center, Medical University of South Carolina, Charleston, SC, USA; Department of Medicine I, University Hospital Giessen and Marburg, Giessen, Germany. Electronic address: matthias.renker@web.de.
Abstract
OBJECTIVE: To comprehensively evaluate quantitative parameters derived from routine coronary CT angiography (cCTA) for predicting lesion-specific ischemia in comparison to invasive fractional flow reserve (FFR). BACKGROUND: The ability of cCTA to gauge lesion-specific ischemia is limited. Several quantitative parameters have been proposed to enhance the specificity of cCTA, such as morphologic indices (lesion length/minimal lumen diameter(4) [LL/MLD(4)]; percentage aggregate plaque volume [%APV]) and a measure of intracoronary contrast gradients (corrected coronary opacification [CCO]). METHODS: Forty-nine patients who had undergone cCTA followed by FFR within 3 months were included. An experienced observer visually assessed all cCTA studies and derived multiple measures characterizing the lesion of interest, including LL, MLD, minimal lumen area (MLA), LL/MLD(4), remodeling index, %APV, and CCO. Lesion-specific ischemia was considered with FFR <0.8. RESULTS: Among 56 lesions, 13 were flow-obstructing by FFR. On univariate analysis, LL, MLD, LL/MLD(4), and CCO showed discriminatory power. The area under the curve of LL/MLD(4) (0.909) was significantly greater compared with MLD (0.802, P = 0.014), LL (0.739, P = 0.041), and CCO (0.809), although the latter did not reach statistical significance (P = 0.175). On multivariate regression, LL/MLD(4) was the only independent predictor of lesion-specific ischemia (odds ratio 2.021, P = 0.001). Moreover, LL/MLD(4) compared favorably to visual cCTA evaluation. CONCLUSION: LL/MLD(4) derived from routine cCTA can enhance the detection of lesion-specific ischemia and may be superior to other described quantitative parameters.
OBJECTIVE: To comprehensively evaluate quantitative parameters derived from routine coronary CT angiography (cCTA) for predicting lesion-specific ischemia in comparison to invasive fractional flow reserve (FFR). BACKGROUND: The ability of cCTA to gauge lesion-specific ischemia is limited. Several quantitative parameters have been proposed to enhance the specificity of cCTA, such as morphologic indices (lesion length/minimal lumen diameter(4) [LL/MLD(4)]; percentage aggregate plaque volume [%APV]) and a measure of intracoronary contrast gradients (corrected coronary opacification [CCO]). METHODS: Forty-nine patients who had undergone cCTA followed by FFR within 3 months were included. An experienced observer visually assessed all cCTA studies and derived multiple measures characterizing the lesion of interest, including LL, MLD, minimal lumen area (MLA), LL/MLD(4), remodeling index, %APV, and CCO. Lesion-specific ischemia was considered with FFR <0.8. RESULTS: Among 56 lesions, 13 were flow-obstructing by FFR. On univariate analysis, LL, MLD, LL/MLD(4), and CCO showed discriminatory power. The area under the curve of LL/MLD(4) (0.909) was significantly greater compared with MLD (0.802, P = 0.014), LL (0.739, P = 0.041), and CCO (0.809), although the latter did not reach statistical significance (P = 0.175). On multivariate regression, LL/MLD(4) was the only independent predictor of lesion-specific ischemia (odds ratio 2.021, P = 0.001). Moreover, LL/MLD(4) compared favorably to visual cCTA evaluation. CONCLUSION: LL/MLD(4) derived from routine cCTA can enhance the detection of lesion-specific ischemia and may be superior to other described quantitative parameters.
Authors: Stefan Baumann; Markus Hirt; Christina Rott; Gökce H Özdemir; Christian Tesche; Tobias Becher; Christel Weiss; Svetlana Hetjens; Ibrahim Akin; Stefan O Schoenberg; Martin Borggrefe; Sonja Janssen; Daniel Overhoff; Dirk Lossnitzer Journal: J Clin Med Date: 2020-03-06 Impact factor: 4.241