Stefan Baumann1, Gökce H Özdemir2, Christian Tesche3, U Joseph Schoepf4, Joseph W Golden4, Tobias Becher5, Markus Hirt2, Christel Weiss6, Matthias Renker7, Ibrahim Akin2, Stefan O Schoenberg8, Martin Borggrefe2, Holger Haubenreisser8, Dirk Lossnitzer2, Daniel Overhoff8. 1. First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Mannheim, Mannheim, Germany. Electronic address: stefan.baumann@umm.de. 2. First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Mannheim, Mannheim, Germany. 3. Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany; Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany; Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 4. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA. 5. First Department of Medicine-Cardiology, University Medical Centre Mannheim, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Mannheim, Mannheim, Germany; Laboratory of Molecular Metabolism, The Rockefeller University, New York, NY, USA. 6. Medical Faculty Mannheim, Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany. 7. Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany. 8. Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, Heidelberg University, Germany.
Abstract
PURPOSE: The study aimed to compare morphological and anatomic plaque markers derived from coronary computed tomography angiography (cCTA) for the detection of lesion specific ischemia with invasive instantaneous wave free ratio (iFR®) as the reference standard. METHODS: In our prospective study, we enrolled patients with suspected coronary artery disease (CAD), who had undergone cCTA, using a low-dose third-generation dual-source CT and invasive coronary angiography (ICA) with iFR® measurement. Various plaque markers were assessed on cCTA. Discriminatory power of these markers for the detection of ischemia-inducing coronary artery disease was evaluated against invasive iFR®. RESULTS: Our study cohort included 39 patients (66.6 ± 12.0 years, 72 % male). Among 54 vessel-specific lesions, 15 lesions (28 %) were characterized as hemodynamically significant by iFR® ≤0.89. The area under the curve (AUC) of lesion length/ minimal luminal diameter4 (LL/MLD4) (0.84) was greater than the AUC of minimal luminal area (MLA) (0.82), MLD (0.81), the degree of luminal diameter stenosis (0.81), corrected coronary opacification (CCO) (0.79), remodeling index (RI) (0.75), and percentage aggregate plaque volume (%APV) (0.72). LL, vessel volume (VV), total plaque volume (TPV), calcified and non-calcified plaque volume (CPV and NCPV) did not reach statistical significance and were unable to discriminate between vessels with and without ischemia-inducing coronary stenosis. CONCLUSION: LL/MLD4, MLA, MLD, the degree of luminal diameter stenosis, CCO, RI, and %APV derived from cCTA can support the detection of hemodynamically significant coronary stenosis as compared with iFR®, with LL/MLD4 showing the greatest discriminatory power.
PURPOSE: The study aimed to compare morphological and anatomic plaque markers derived from coronary computed tomography angiography (cCTA) for the detection of lesion specific ischemia with invasive instantaneous wave free ratio (iFR®) as the reference standard. METHODS: In our prospective study, we enrolled patients with suspected coronary artery disease (CAD), who had undergone cCTA, using a low-dose third-generation dual-source CT and invasive coronary angiography (ICA) with iFR® measurement. Various plaque markers were assessed on cCTA. Discriminatory power of these markers for the detection of ischemia-inducing coronary artery disease was evaluated against invasive iFR®. RESULTS: Our study cohort included 39 patients (66.6 ± 12.0 years, 72 % male). Among 54 vessel-specific lesions, 15 lesions (28 %) were characterized as hemodynamically significant by iFR® ≤0.89. The area under the curve (AUC) of lesion length/ minimal luminal diameter4 (LL/MLD4) (0.84) was greater than the AUC of minimal luminal area (MLA) (0.82), MLD (0.81), the degree of luminal diameter stenosis (0.81), corrected coronary opacification (CCO) (0.79), remodeling index (RI) (0.75), and percentage aggregate plaque volume (%APV) (0.72). LL, vessel volume (VV), total plaque volume (TPV), calcified and non-calcified plaque volume (CPV and NCPV) did not reach statistical significance and were unable to discriminate between vessels with and without ischemia-inducing coronary stenosis. CONCLUSION: LL/MLD4, MLA, MLD, the degree of luminal diameter stenosis, CCO, RI, and %APV derived from cCTA can support the detection of hemodynamically significant coronary stenosis as compared with iFR®, with LL/MLD4 showing the greatest discriminatory power.
Authors: S Baumann; D Overhoff; C Tesche; G Korosoglou; S Kelle; M Nassar; S J Buss; F Andre; M Renker; U J Schoepf; I Akin; S Waldeck; S O Schoenberg; D Lossnitzer Journal: Herz Date: 2022-03-04 Impact factor: 1.443
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