Charles A Taylor1, Sara Gaur2, Jonathon Leipsic3, Stephan Achenbach4, Daniel S Berman5, Jesper M Jensen2, Damini Dey5, Hans Erik Bøtker2, Hyun Jin Kim6, Sophie Khem6, Alan Wilk6, Christopher K Zarins6, Hiram Bezerra7, John Lesser8, Brian Ko9, Jagat Narula10, Amir Ahmadi10, Kristian A Øvrehus2, Fred St Goar11, Bernard De Bruyne12, Bjarne L Nørgaard2. 1. HeartFlow, Inc., Redwood City, CA, USA; Department of Bioengineering, Stanford University, Stanford, CA, USA. Electronic address: ctaylor@heartflow.com. 2. Department of Cardiology, Aarhus University Hospital Skejby, Aarhus, Denmark. 3. Department of Radiology and Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada. 4. Department of Cardiology, Erlangen, Germany. 5. Department of Cardiology, Cedars Sinai Hospital, Los Angeles, CA, USA. 6. HeartFlow, Inc., Redwood City, CA, USA. 7. Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals Cleveland, Ohio, USA. 8. Minneapolis Heart Institute, Minneapolis, MN, USA. 9. Monash Heart, Monash Medical Center and Monash University, Victoria, Australia. 10. Department of Cardiology, Mount Sinai Hospital, New York, NY, USA. 11. Department of Cardiology, El Camino Hospital, Mountain View, CA, USA. 12. Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium.
Abstract
BACKGROUND: We hypothesize that in patients with suspected coronary artery disease (CAD), lower values of the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) result in lower fractional flow reserve (FFR). METHODS: V/M was computed in 238 patients from the NXT trial who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography (QCA) and FFR measurement in 438 vessels. Nitroglycerin was administered prior to CT, QCA and FFR acquisition. The V/M ratio was quantified on a patient-level from CT image data by segmenting the epicardial coronary arterial lumen volume (V) and the left ventricular myocardial mass (M). Calcified and noncalcified plaque volumes were quantified using semi-automated software. RESULTS: The median value of V/M (18.57 mm3/g) was used to define equal groups of low and high V/M patients. Patients with low V/M had greater diameter stenosis by QCA, more plaque and lower FFR (0.80 ± 0.12 vs. 0.87 ± 0.08; P < 0.0001) than those with high V/M. A total of 365 vessels in 202 patients had QCA stenosis ≤50% and measured FFR. In these patients, those with low V/M had higher percent diameter stenosis by QCA, greater total plaque volume and lower FFR (0.81 ± 0.12 vs. 0.88 ± 0.07; P < 0.0001) than those with high V/M. In multivariate logistic regression analysis, V/M was an independent predictor of FFR ≤0.80 (all p-values < 0.001). CONCLUSIONS: Patients with a low V/M ratio have lower FFR overall and in non-obstructive CAD, independent of plaque measures.
BACKGROUND: We hypothesize that in patients with suspected coronary artery disease (CAD), lower values of the ratio of total epicardial coronary arterial lumen volume to left ventricular myocardial mass (V/M) result in lower fractional flow reserve (FFR). METHODS: V/M was computed in 238 patients from the NXT trial who underwent coronary computed tomography angiography (CTA), quantitative coronary angiography (QCA) and FFR measurement in 438 vessels. Nitroglycerin was administered prior to CT, QCA and FFR acquisition. The V/M ratio was quantified on a patient-level from CT image data by segmenting the epicardial coronary arterial lumen volume (V) and the left ventricular myocardial mass (M). Calcified and noncalcified plaque volumes were quantified using semi-automated software. RESULTS: The median value of V/M (18.57 mm3/g) was used to define equal groups of low and high V/M patients. Patients with low V/M had greater diameter stenosis by QCA, more plaque and lower FFR (0.80 ± 0.12 vs. 0.87 ± 0.08; P < 0.0001) than those with high V/M. A total of 365 vessels in 202 patients had QCA stenosis ≤50% and measured FFR. In these patients, those with low V/M had higher percent diameter stenosis by QCA, greater total plaque volume and lower FFR (0.81 ± 0.12 vs. 0.88 ± 0.07; P < 0.0001) than those with high V/M. In multivariate logistic regression analysis, V/M was an independent predictor of FFR ≤0.80 (all p-values < 0.001). CONCLUSIONS:Patients with a low V/M ratio have lower FFR overall and in non-obstructive CAD, independent of plaque measures.
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