Amir Ahmadi1, Jonathon Leipsic2, Kristian A Øvrehus3, Sara Gaur3, Emilia Bagiella4, Brian Ko5, Damini Dey6, Gina LaRocca4, Jesper M Jensen3, Hans Erik Bøtker3, Stephan Achenbach7, Bernard De Bruyne8, Bjarne L Nørgaard3, Jagat Narula9. 1. Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Cardiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada. 2. Division of Cardiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada. 3. Division of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 4. Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. 5. Division of Cardiology, Monash University, Melbourne, Australia. 6. Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California. 7. Division of Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany. 8. Division of Cardiology, Cardiovascular Center Aalst, Aalst, Belgium. 9. Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: narula@mountsinai.org.
Abstract
OBJECTIVES: The aims of the present study were: 1) to investigate the contribution of the extent of luminal stenosis and other lesion composition-related factors in predicting invasive fractional flow reserve (FFR); and 2) to explore the distribution of various combinations of morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR. BACKGROUND: In patients with stable ischemic heart disease, FFR-guided revascularization, as compared with medical therapy alone, is reported to improve outcomes. Because morphological characteristics are the basis of plaque rupture and acute coronary events, a relationship between FFR and lesion characteristics may exist. METHODS: This is a subanalysis of NXT (HeartFlowNXT: HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography), a prospective, multicenter study of 254 patients (age 64 ± 10 years, 64% male) with suspected stable ischemic heart disease; coronary computed tomography angiography including plaque morphology assessment, invasive angiography, and FFR were obtained for 383 lesions. Ischemia was defined by invasive FFR ≤0.80. Computed tomography angiography-defined morphological characteristics of plaques and their vascular location were used in univariate and multivariate analyses to examine their predictive value for invasive FFR. The distribution of various combinations of plaque morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR were examined. RESULTS: The percentage of luminal stenosis, low-attenuation plaque (LAP) or necrotic core volume, left anterior descending coronary artery territory, and the presence of multiple lesions per vessel were the predictors of FFR. When grouped on the basis of degree of luminal stenosis, FFR-negative lesions had consistently smaller LAP volumes compared with FFR-positive lesions. The distribution of plaque characteristics in lesions with normal and abnormal FFR demonstrated that whereas FFR-negative lesions excluded likelihood of stenotic plaques with moderate to high LAP volumes, only one-third of FFR-positive lesions demonstrated obstructive plaques with moderate to high LAP volumes. CONCLUSIONS: In addition to the severity of luminal stenosis, necrotic core volume is an independent predictor of FFR. The distribution of plaque characteristics among lesions with varying luminal stenosis and normal and abnormal FFR may explain the outcomes associated with FFR-guided therapy.
OBJECTIVES: The aims of the present study were: 1) to investigate the contribution of the extent of luminal stenosis and other lesion composition-related factors in predicting invasive fractional flow reserve (FFR); and 2) to explore the distribution of various combinations of morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR. BACKGROUND: In patients with stable ischemic heart disease, FFR-guided revascularization, as compared with medical therapy alone, is reported to improve outcomes. Because morphological characteristics are the basis of plaque rupture and acute coronary events, a relationship between FFR and lesion characteristics may exist. METHODS: This is a subanalysis of NXT (HeartFlowNXT: HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography), a prospective, multicenter study of 254 patients (age 64 ± 10 years, 64% male) with suspected stable ischemic heart disease; coronary computed tomography angiography including plaque morphology assessment, invasive angiography, and FFR were obtained for 383 lesions. Ischemia was defined by invasive FFR ≤0.80. Computed tomography angiography-defined morphological characteristics of plaques and their vascular location were used in univariate and multivariate analyses to examine their predictive value for invasive FFR. The distribution of various combinations of plaque morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR were examined. RESULTS: The percentage of luminal stenosis, low-attenuation plaque (LAP) or necrotic core volume, left anterior descending coronary artery territory, and the presence of multiple lesions per vessel were the predictors of FFR. When grouped on the basis of degree of luminal stenosis, FFR-negative lesions had consistently smaller LAP volumes compared with FFR-positive lesions. The distribution of plaque characteristics in lesions with normal and abnormal FFR demonstrated that whereas FFR-negative lesions excluded likelihood of stenotic plaques with moderate to high LAP volumes, only one-third of FFR-positive lesions demonstrated obstructive plaques with moderate to high LAP volumes. CONCLUSIONS: In addition to the severity of luminal stenosis, necrotic core volume is an independent predictor of FFR. The distribution of plaque characteristics among lesions with varying luminal stenosis and normal and abnormal FFR may explain the outcomes associated with FFR-guided therapy.
Authors: Harmony R Reynolds; C Noel Bairey Merz; Colin Berry; Rohit Samuel; Jacqueline Saw; Nathaniel R Smilowitz; Ana Carolina do A H de Souza; Robert Sykes; Viviany R Taqueti; Janet Wei Journal: Circ Res Date: 2022-02-17 Impact factor: 17.367
Authors: Farhan Chaudhry; Hideki Kawai; Kipp W Johnson; Navneet Narula; Aditya Shekhar; Fayzan Chaudhry; Takehiro Nakahara; Takashi Tanimoto; Dongbin Kim; Matthew K M Y Adapoe; Francis G Blankenberg; Jeffrey A Mattis; Koon Y Pak; Phillip D Levy; Yukio Ozaki; Eloisa Arbustini; H William Strauss; Artiom Petrov; Valentin Fuster; Jagat Narula Journal: J Am Coll Cardiol Date: 2020-10-20 Impact factor: 24.094
Authors: Inge J van den Hoogen; Alexander R van Rosendael; Fay Y Lin; Jeroen J Bax; Leslee J Shaw; James K Min Journal: Curr Cardiovasc Imaging Rep Date: 2019-05-14
Authors: Jagat Narula; Y Chandrashekhar; Amir Ahmadi; Suhny Abbara; Daniel S Berman; Ron Blankstein; Jonathon Leipsic; David Newby; Edward D Nicol; Koen Nieman; Leslee Shaw; Todd C Villines; Michelle Williams; Harvey S Hecht Journal: J Cardiovasc Comput Tomogr Date: 2020-11-20
Authors: Sara Seitun; Cecilia De Lorenzi; Filippo Cademartiri; Angelo Buscaglia; Nicole Travaglio; Manrico Balbi; Gian Paolo Bezante Journal: Biomed Res Int Date: 2018-10-14 Impact factor: 3.411