Hironori Kitabata1, Jonathon Leipsic2, Manesh R Patel3, Koen Nieman4, Bernard De Bruyne5, Campbell Rogers6, Gianluca Pontone7, Bjarne L Nørgaard8, Jeroen J Bax9, Gilbert Raff10, Kavitha M Chinnaiyan10, Mark Rabbat11, Niels Peter Rønnow Sand12, Philipp Blanke13, Timothy A Fairbairn14, Hitoshi Matsuo15, Tetsuya Amano16, Tomohiro Kawasaki17, Yoshihiro Morino18, Takashi Akasaka1. 1. Wakayama Medical University, Wakayama, Japan. 2. Department of Radiology, University of British Columbia, Vancouver, BC, Canada. Electronic address: jleipsic@providencehealth.bc.ca. 3. Duke University School of Medicine, Durham, NC, USA. 4. Erasmus Medical Center, Rotterdam, The Netherlands. 5. Onze-Lieve-Vrouwziekenhuis Aalst, Aalst, Belgium. 6. HeartFlow, Redwood City, CA, USA. 7. Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy, Yonsei University Health System, Seoul, South Korea. 8. Aarhus University Hospital, Aarhus Skejby, Denmark. 9. Leiden University Medical Center, Leiden, The Netherlands. 10. William Beaumont Hospital, Royal Oaks, MI, USA. 11. Loyola University Medical Center, Maywood, IL, USA. 12. University of Southern Denmark, Odense, Denmark. 13. Department of Radiology, University of British Columbia, Vancouver, BC, Canada. 14. Liverpool Heart and Chest Hospital, Liverpool, UK. 15. Gifu Heart Center, Gifu, Japan. 16. Aichi Medical University, Aichi, Japan. 17. Shin Koga Hospital, Fukuoka, Japan. 18. Iwate Medical University, Iwate, Japan.
Abstract
BACKGROUND: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry. METHODS: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFRCT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFRCT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFRCT. RESULTS: FFRCT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFRCT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFRCT than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFRCT. In addition, >70% stenosis was significantly associated with low FFRCT (OR 31.16, 95%CI 12.25-79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30-49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52-9.17, p < 0.0001). CONCLUSIONS: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFRCT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.
BACKGROUND: To date, the clinical utility of coronary computed tomography angiography (CTA)-derived fractional flow reserve (FFRCT) has been limited to trials and single center experiences. We herein report the incidence of abnormal FFRCT (≤0.80) and the relationship of lesion-specific ischemia to subject demographics, symptoms, and degree of stenosis in the multicenter, prospective ADVANCE registry. METHODS: One thousand patients with suspected angina having documented coronary artery disease on coronary CTA and clinically referred for FFRCT were prospectively enrolled in the registry. Patient demographics, symptom status, coronary CTA and FFRCT findings were recorded. Univariate and multivariate analyses were performed to investigate the predictors related to abnormal FFRCT. RESULTS: FFRCT data were analyzed in 952 patients (95.2%). Overall, 51.1% patients had a positive FFRCT value (≤0.80). Patients with ≥3 risk factors had a significantly higher rate of abnormal FFRCT than those with <3 risk factors (60.2% vs. 43.9%, p = 0.0001). On multivariate analysis, baseline diabetes (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.04-2.21, p = 0.030) and hypertension (OR 1.56, 95%CI 1.14-2.14, p = 0.005) were both predictive of abnormal FFRCT. In addition, >70% stenosis was significantly associated with low FFRCT (OR 31.16, 95%CI 12.25-79.22, p < 0.0001) vs. <30% stenosis. Notably, stenosis 30-49% vs. <30% had an increased likelihood of ischemia (OR 3.74, 95%CI 1.52-9.17, p < 0.0001). CONCLUSIONS: In this real-world registry, CT angiographic stenosis severity in addition to baseline cardiovascular risk factors conferred an increased likelihood of an abnormal FFRCT. Importantly, however, mild CT angiographic stenoses were noted to have an increased hazard for ischemia and the converse holding true for more severe stenoses as well.
Authors: Charis G McNabney; Stephanie L Sellers; Ryan J A Wilson; Shmuel Hart; Samuel A Rosenblatt; Darra T Murphy; Philipp Blanke; Amir A Ahmadi; Jaydeep Halankar; Adrian Attinger-Toller; Marcelo Godoy Zamorano; Janice Wong Li Yu; Bjarne L Nørgaard; Jonathon A Leipsic; Jonathan R Weir-McCall Journal: Radiol Cardiothorac Imaging Date: 2019-06-27