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Evaluation of epicardial coronary resistance using computed tomography angiography: A Proof of Concept |
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| Institution: | 1. Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands;2. Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands;3. Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;4. Coronary Disease and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland;5. Department of Radiology and Radiological Science, Heart & Vascular Center, Medical University of South Carolina, Charleston, South Carolina;6. Department of Radiology and Department of Medical and Health Sciences, Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden;7. Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea;8. Department of Radiology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan;9. Stanford University School of Medicine, Cardiovascular Institute, Stanford, California |
| Abstract: | AimsFractional flow reserve (FFR) pullback allows to assess the distribution of pressure loss along the coronary vessels. FFR derived from CT (FFRCT) provides a virtual pullback curve that may also aid in the assessment of the distribution of epicardial coronary resistance in the non-invasive setting. The present study aims to determine the accuracy of the virtual FFRCT pullback curve using a motorized invasive FFR pullback as reference in patients with stable coronary artery disease.Methods and resultsFFR values were extracted from coronary vessels at approximately 1 mm to generate pullback curves. Invasive motorized FFR pullbacks were acquired using a dedicated device at a speed of 1 mm/s. A total of 3172 matched FFRCT and FFR values were obtained in 24 vessels. The correlation coefficient between FFRCT and FFR was 0.76 (95%CI 0.75 to 0.78; p < 0.001). The area under the pullback curve was similar between FFRCT and invasive FFR (79.0 ± 16.1 vs. 85.3 ± 16.4, p = 0.097). The mean difference in lesion gradient between FFRCT and FFR was ?0.07 (LOA -0.26 to 0.13) whereas in non-obstructive segments was ?0.01 (LOA -0.06 to 0.05).ConclusionThe evaluation of epicardial coronary resistance using coronary CT angiography with FFRCT was feasible. FFRCT virtual pullback appears to be accurate for the evaluation of pressure gradients. FFRCT has the potential to identify the pathophysiological pattern of coronary artery disease in the non-invasive setting. |
| Keywords: | FFR"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"fractional flow reserve CT"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"computed tomography CTA"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"computed tomography angiography FFRCT"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"fractional flow reserve derived from computed tomography angiography LOA"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"limits of agreement 95% CI"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"95% confidence interval QCA"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"quantitative coronary analysis MAP"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"moderate attenuation plaque LAP"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"low attenuation plaque IQR"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"interquartile range IMR"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"index of microcirculatory resistance |
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