Xu Dai1, Yang Hou2, Chunxiang Tang3, Zhigang Lu4, Chengxing Shen4, Longjiang Zhang3, Jiayin Zhang5. 1. Institute of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. 2. Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China. 3. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. 4. Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China. 5. Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Abstract
BACKGROUND: To investigate the serial changes of computed tomography (CT) fractional flow reserve (CT-FFR) and fat attenuation index (FAI), and explore their relationships with long-term clinical outcomes. METHODS: Consecutive symptomatic patients with an intermediate pretest probability of coronary artery disease 1-4 were prospectively enrolled if coronary CT angiography (CCTA) revealed at least 1 lesion with 30-70% stenosis on major epicardial arteries. Follow-up CCTA was performed at 1 to 1.5-year intervals. All patients were further followed up after the second CCTA until September 2019. The Coronary Artery Disease - Reporting and Data System (CAD-RADS) grade, high-risk plaque features, lesion-specific CT-FFR, and FAI were measured for prognosis analysis. RESULTS: A total of 263 patients were included in the analysis, and 38 major adverse cardiac events (MACEs) occurred. In the MACE group, the lesion-specific CT-FFR decreased significantly at the follow-up CCTA [0.80 (0.74-0.90) versus 0.85 (0.76-0.93); P=0.01], whereas the FAI did not notably increase (-70.4±8.9 versus -71.3±7.1 HU; P=0.436). In the non-MACE group, lesion-specific CT-FFR increased markedly [0.91 (0.84-0.95) versus 0.90 (0.82-0.94); P<0.001], while the FAI decreased substantially (-74.0±10.8 versus -72.4±11.5 HU; P=0.004). Decreased CT-FFR (adjusted overall hazard ratio =2.455; P=0.023) and increased FAI (adjusted hazard ratio =2.956; P=0.002) were the strongest independent predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value (Concordance statistic =0.716; P=0.003; over conventional clinical and imaging parameters (Concordance statistic =0.762; P=0.004). CONCLUSIONS: Decreased CT-FFR and increased FAI at follow-up CCTA were the 2 strongest predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value over conventional clinical and imaging parameters for risk stratification. In addition, decreased CT-FFR provided incremental predictive value for MACEs from 15 months after second CCTA, while increased FAI added prognostic value from the second CCTA onwards. 2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.
BACKGROUND: To investigate the serial changes of computed tomography (CT) fractional flow reserve (CT-FFR) and fat attenuation index (FAI), and explore their relationships with long-term clinical outcomes. METHODS: Consecutive symptomatic patients with an intermediate pretest probability of coronary artery disease 1-4 were prospectively enrolled if coronary CT angiography (CCTA) revealed at least 1 lesion with 30-70% stenosis on major epicardial arteries. Follow-up CCTA was performed at 1 to 1.5-year intervals. All patients were further followed up after the second CCTA until September 2019. The Coronary Artery Disease - Reporting and Data System (CAD-RADS) grade, high-risk plaque features, lesion-specific CT-FFR, and FAI were measured for prognosis analysis. RESULTS: A total of 263 patients were included in the analysis, and 38 major adverse cardiac events (MACEs) occurred. In the MACE group, the lesion-specific CT-FFR decreased significantly at the follow-up CCTA [0.80 (0.74-0.90) versus 0.85 (0.76-0.93); P=0.01], whereas the FAI did not notably increase (-70.4±8.9 versus -71.3±7.1 HU; P=0.436). In the non-MACE group, lesion-specific CT-FFR increased markedly [0.91 (0.84-0.95) versus 0.90 (0.82-0.94); P<0.001], while the FAI decreased substantially (-74.0±10.8 versus -72.4±11.5 HU; P=0.004). Decreased CT-FFR (adjusted overall hazard ratio =2.455; P=0.023) and increased FAI (adjusted hazard ratio =2.956; P=0.002) were the strongest independent predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value (Concordance statistic =0.716; P=0.003; over conventional clinical and imaging parameters (Concordance statistic =0.762; P=0.004). CONCLUSIONS: Decreased CT-FFR and increased FAI at follow-up CCTA were the 2 strongest predictors of MACEs. Serial changes of CT-FFR and FAI provided incremental prognostic value over conventional clinical and imaging parameters for risk stratification. In addition, decreased CT-FFR provided incremental predictive value for MACEs from 15 months after second CCTA, while increased FAI added prognostic value from the second CCTA onwards. 2022 Quantitative Imaging in Medicine and Surgery. All rights reserved.
Authors: Philipp L von Knebel Doeberitz; Carlo N De Cecco; U Joseph Schoepf; Moritz H Albrecht; Marly van Assen; Domenico De Santis; Jeffrey Gaskins; Simon Martin; Maximilian J Bauer; Ullrich Ebersberger; Dante A Giovagnoli; Akos Varga-Szemes; Richard R Bayer; Stefan O Schönberg; Christian Tesche Journal: Am J Cardiol Date: 2019-08-08 Impact factor: 2.778
Authors: Christian Tesche; Carlo N De Cecco; Stefan Baumann; Matthias Renker; Tindal W McLaurin; Taylor M Duguay; Richard R Bayer; Daniel H Steinberg; Katharine L Grant; Christian Canstein; Chris Schwemmer; Max Schoebinger; Lucian M Itu; Saikiran Rapaka; Puneet Sharma; U Joseph Schoepf Journal: Radiology Date: 2018-04-10 Impact factor: 11.105
Authors: Evangelos K Oikonomou; Mohamed Marwan; Milind Y Desai; Jennifer Mancio; Alaa Alashi; Erika Hutt Centeno; Sheena Thomas; Laura Herdman; Christos P Kotanidis; Katharine E Thomas; Brian P Griffin; Scott D Flamm; Alexios S Antonopoulos; Cheerag Shirodaria; Nikant Sabharwal; John Deanfield; Stefan Neubauer; Jemma C Hopewell; Keith M Channon; Stephan Achenbach; Charalambos Antoniades Journal: Lancet Date: 2018-08-28 Impact factor: 79.321