Maros Ferencik1, Michael T Lu2, Thomas Mayrhofer3, Stefan B Puchner4, Ting Liu5, Pal Maurovich-Horvat6, Khristine Ghemigian2, Alexander Ivanov2, Elizabeth Adami2, John T Nagurney7, Pamela K Woodard8, Quynh A Truong9, James E Udelson10, Udo Hoffmann2. 1. Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA; Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: ferencik@ohsu.edu. 2. Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 3. Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; School of Business Studies, Stralsund University of Applied Sciences, Stralsund, Germany. 4. Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria. 5. Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Radiology, First Affiliated Hospital of China Medical University, Shenyang, China. 6. MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Centre, Semmelweis University, Budapest, Hungary. 7. Department of Emergency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 8. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA. 9. Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA. 10. Division of Cardiology and the Cardio-Vascular Center, Tufts Medical Center, Boston, MA, USA.
Abstract
BACKGROUND: Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFRCT in the population of acute chest pain patients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. METHODS: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFRCT was measured in a core laboratory. RESULTS: We found correlation between anatomic severity of stenosis and FFRCT ≤0.80 vs. FFRCT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFRCT values (median 0.64, 25th-75th percentile 0.50-0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78-0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFRCT ≤0.80 was 4.03 (95% CI 1.56-10.36) and 3.50 (95% CI 1.12-10.96), respectively. FFRCT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55-9.85, p = 0.004) after adjustment for stenosis severity. CONCLUSION: Abnormal FFRCT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFRCT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.
BACKGROUND: Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest painpatients. We determined feasibility of FFRCT in the population of acute chest painpatients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. METHODS: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFRCT was measured in a core laboratory. RESULTS: We found correlation between anatomic severity of stenosis and FFRCT ≤0.80 vs. FFRCT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFRCT values (median 0.64, 25th-75th percentile 0.50-0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78-0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFRCT ≤0.80 was 4.03 (95% CI 1.56-10.36) and 3.50 (95% CI 1.12-10.96), respectively. FFRCT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55-9.85, p = 0.004) after adjustment for stenosis severity. CONCLUSION: Abnormal FFRCT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFRCT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.
Authors: Harold I Litt; Constantine Gatsonis; Brad Snyder; Harjit Singh; Chadwick D Miller; Daniel W Entrikin; James M Leaming; Laurence J Gavin; Charissa B Pacella; Judd E Hollander Journal: N Engl J Med Date: 2012-03-26 Impact factor: 91.245
Authors: Michael T Lu; Nandini M Meyersohn; Thomas Mayrhofer; Daniel O Bittner; Hamed Emami; Stefan B Puchner; Borek Foldyna; Martin E Mueller; Steven Hearne; Clifford Yang; Stephan Achenbach; Quynh A Truong; Brian B Ghoshhajra; Manesh R Patel; Maros Ferencik; Pamela S Douglas; Udo Hoffmann Journal: Radiology Date: 2017-11-27 Impact factor: 11.105
Authors: Roel S Driessen; Ibrahim Danad; Wijnand J Stuijfzand; Pieter G Raijmakers; Stefan P Schumacher; Pepijn A van Diemen; Jonathon A Leipsic; Juhani Knuuti; S Richard Underwood; Peter M van de Ven; Albert C van Rossum; Charles A Taylor; Paul Knaapen Journal: J Am Coll Cardiol Date: 2019-01-22 Impact factor: 24.094
Authors: Michael T Lu; Maros Ferencik; Rhonda S Roberts; Kerry L Lee; Alexander Ivanov; Elizabeth Adami; Daniel B Mark; Farouc A Jaffer; Jonathon A Leipsic; Pamela S Douglas; Udo Hoffmann Journal: JACC Cardiovasc Imaging Date: 2017-04-12
Authors: Maros Ferencik; Thomas Mayrhofer; Stefan B Puchner; Michael T Lu; Pal Maurovich-Horvat; Ting Liu; Khristine Ghemigian; Pieter Kitslaar; Alexander Broersen; Fabian Bamberg; Quynh A Truong; Christopher L Schlett; Udo Hoffmann Journal: J Cardiovasc Comput Tomogr Date: 2015-07-10
Authors: Udo Hoffmann; Quynh A Truong; David A Schoenfeld; Eric T Chou; Pamela K Woodard; John T Nagurney; J Hector Pope; Thomas H Hauser; Charles S White; Scott G Weiner; Shant Kalanjian; Michael E Mullins; Issam Mikati; W Frank Peacock; Pearl Zakroysky; Douglas Hayden; Alexander Goehler; Hang Lee; G Scott Gazelle; Stephen D Wiviott; Jerome L Fleg; James E Udelson Journal: N Engl J Med Date: 2012-07-26 Impact factor: 91.245
Authors: Bjarne L Nørgaard; Jonathon Leipsic; Sara Gaur; Sujith Seneviratne; Brian S Ko; Hiroshi Ito; Jesper M Jensen; Laura Mauri; Bernard De Bruyne; Hiram Bezerra; Kazuhiro Osawa; Mohamed Marwan; Christoph Naber; Andrejs Erglis; Seung-Jung Park; Evald H Christiansen; Anne Kaltoft; Jens F Lassen; Hans Erik Bøtker; Stephan Achenbach Journal: J Am Coll Cardiol Date: 2014-01-30 Impact factor: 24.094
Authors: Pamela S Douglas; Gianluca Pontone; Mark A Hlatky; Manesh R Patel; Bjarne L Norgaard; Robert A Byrne; Nick Curzen; Ian Purcell; Matthias Gutberlet; Gilles Rioufol; Ulrich Hink; Herwig Walter Schuchlenz; Gudrun Feuchtner; Martine Gilard; Daniele Andreini; Jesper M Jensen; Martin Hadamitzky; Karen Chiswell; Derek Cyr; Alan Wilk; Furong Wang; Campbell Rogers; Bernard De Bruyne Journal: Eur Heart J Date: 2015-09-01 Impact factor: 29.983
Authors: Sara Gaur; Kristian Altern Øvrehus; Damini Dey; Jonathon Leipsic; Hans Erik Bøtker; Jesper Møller Jensen; Jagat Narula; Amir Ahmadi; Stephan Achenbach; Brian S Ko; Evald Høj Christiansen; Anne Kjer Kaltoft; Daniel S Berman; Hiram Bezerra; Jens Flensted Lassen; Bjarne Linde Nørgaard Journal: Eur Heart J Date: 2016-01-12 Impact factor: 29.983
Authors: Matthias Eberhard; Tin Nadarevic; Andrej Cousin; Jochen von Spiczak; Ricarda Hinzpeter; Andre Euler; Fabian Morsbach; Robert Manka; Dagmar I Keller; Hatem Alkadhi Journal: Cardiovasc Diagn Ther Date: 2020-08