Advanced computed tomographic anatomical and morphometric plaque analysis for prediction of fractional flow reserve in intermediate coronary lesions |
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Authors: | Maksymilian P. Opolski Cezary Kepka Stephan Achenbach Jerzy Pregowski Mariusz Kruk Adam D. Staruch Jacek Kadziela Witold Ruzyllo Adam Witkowski |
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Affiliation: | 1. Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland;2. Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland;3. Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany;4. Medical University of Warsaw, Warsaw, Poland |
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Abstract: | ObjectiveTo determine the application of advanced coronary computed tomography angiography (CCTA) plaque analysis for predicting invasive fractional flow reserve (FFR) in intermediate coronary lesions.MethodsSixty-one patients with 71 single intermediate coronary lesions (≥50–80% stenosis) on CCTA prospectively underwent coronary angiography and FFR. Advanced anatomical and morphometric plaque analysis was performed based on CCTA data set to determine optimal criteria for significant flow impairment. A significant stenosis was defined as FFR ≤ 0.80.ResultsFFR averaged 0.85 ± 0.09, and 19 lesions (27%) were functionally significant. FFR correlated with minimum lumen area (MLA) (r = 0.456, p < 0.001), minimum lumen diameter (MLD) (r = 0.326, p = 0.006), reference lumen diameter (RLD) (r = 0.245, p = 0.039), plaque burden (r = −0.313, p = 0.008), lumen area stenosis (r = −0.305, p = 0.01), lesion length (r = −0.692, p < 0.001), and plaque volume (r = −0.668, p < 0.001). There was no relationship between FFR and CCTA morphometric plaque parameters. By multivariate analysis the independent predictors of FFR were lesion length (beta = −0.581, p < 0.001), MLA (beta = 0.360, p = 0.041), and RLD (beta = −0.255, p = 0.036). The optimal cutoffs for lesion length, MLA, MLD, RLD, and lumen area stenosis were >18.5 mm, ≤3.0 mm2, ≤2.1 mm, ≤3.2 mm, and >69%, respectively (max. sensitivity: 100% for MLA, max. specificity: 79% for lumen area stenosis).ConclusionsCCTA predictors for FFR support the mathematical relationship between stenosis pressure drop and coronary flow. CCTA could prove to be a useful rule-out test for significant hemodynamic effects of intermediate coronary stenoses. |
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Keywords: | Coronary computed tomography angiography Fractional flow reserve Intermediate coronary stenosis |
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