Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRct |
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| Institution: | 1. Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA;2. Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA;3. Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada;1. Department of Cardiovascular Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy;2. Department of Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, Milan, Italy;3. Department of Statistics Centro Cardiologico Monzino, IRCCS, Milan, Italy;4. Department of Anaesthesia and Intensive Care, Cardiothoracic Center, Istituto Clinico Sant’Ambrogio, Milan, Italy;5. Department of Cardiovascular Sciences and Community Health, University of Milan, Italy;1. Department of Medicine, Loyola University Medical Center, Maywood, IL, USA;2. Rush University Medical Center, Division of Cardiology, Chicago, IL, USA;1. Department of Cardiology, Hospital Unit West, Herning, Denmark;2. Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark;3. Department of Clinical Epidemiology, Aarhus University Hospital, Denmark;4. Department of Nuclear Medicine, Aarhus University Hospital, Aarhus, Denmark;5. Department of Cardiology, Lillebaelt Hospital-Vejle, Vejle, Denmark;6. Department of Cardiology, Aarhus University Hospital, Denmark;7. Department of Cardiology, Odense University Hospital, Odense, Denmark;8. Department of Cardiology, Regional Hospital of Silkeborg, Silkeborg, Denmark;9. Department of Cardiology, Odense University Hospital, Svendborg, Denmark;10. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark;11. Department of Cardiology, Regional Hospital of South Jutland, Aabenraa, Denmark;12. Department of Cardiology, Regional Hospital of South West Denmark, Esbjerg, Denmark;13. Department of Cardiology, Regional Hospital of Northern Jutland, Hjørring, Denmark;1. Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA;2. Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA |
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| Abstract: | IntroductionThe degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone.MethodsPer-vessel FFRct was computed in 1,395 vessels of 836 patients undergoing CCTA with 25–99% maximal stenosis. By consensus analysis, stenosis severity was graded as 25–49%, 50–69%, 70–89%, and 90–99%. HRPs including low attenuation plaque (LAP), positive remodeling (PR), and spotty calcification (SC) were assessed in lesions with maximal stenosis. Lesion FFRct was measured distal to the lesion with maximal stenosis, and FFRct<0.80 was defined as abnormal. Association of HRP and abnormal lesion FFRct was evaluated by univariable and multivariable logistic regression models.ResultsThe frequency of abnormal lesion FFRct increased with increase of stenosis severity across each stenosis category (25–49%:6%; 50–69%:30%; 70–89%:54%; 90–99%:91%, p ?< ?0.001). Univariable analysis demonstrated that stenosis severity, LAP, and PR were predictive of abnormal lesion FFRct, while SC was not. In multivariable analyses considering stenosis severity, presence of PR, LAP, and PR and/or LAP were independently associated with abnormal FFRct: Odds ratio 1.58, 1.68, and 1.53, respectively (p ?< ?0.02 for all). The presence of PR and/or LAP increased the frequency of abnormal FFRct with mild stenosis (p ?< ?0.05) with a similar trend with 70–89% stenosis. The combination of 2 HRP (LAP and PR) identified more lesions with FFR < 0.80 than only 1 HRP.ConclusionsSemiquantitative visual assessment of high-risk plaque features may improve the selection of studies for FFRct. |
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| Keywords: | FFRct High-risk plaque features Coronary CT angiography |
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