Combined Coronary CT-Angiography and TAVI Planning: Utility of CT-FFR in Patients with Morphologically Ruled-Out Obstructive Coronary Artery Disease.

Autor: Gohmann RF; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany., Seitz P; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Pawelka K; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany., Majunke N; Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Schug A; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany., Heiser L; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Renatus K; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany., Desch S; Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Lauten P; Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Holzhey D; Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Noack T; Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Wilde J; Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Kiefer P; Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Krieghoff C; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Lücke C; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Ebel S; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany., Gottschling S; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Borger MA; Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany., Thiele H; Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany., Panknin C; Siemens Healthcare GmbH, Henkestr. 127, 91052 Erlangen, Germany., Abdel-Wahab M; Department of Cardiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany., Horn M; Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstr. 16-18, 04107 Leipzig, Germany., Gutberlet M; Department of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.; Medical Faculty, University of Leipzig, Liebigstr. 27, 04103 Leipzig, Germany.; Leipzig Heart Institute, Russenstr. 69a, 04289 Leipzig, Germany.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2022 Feb 28; Vol. 11 (5). Date of Electronic Publication: 2022 Feb 28.
DOI: 10.3390/jcm11051331
Abstrakt: Background : Coronary artery disease (CAD) is a frequent comorbidity in patients undergoing transcatheter aortic valve implantation (TAVI). If significant CAD can be excluded on coronary CT-angiography (cCTA), invasive coronary angiography (ICA) may be avoided. However, a high plaque burden may make the exclusion of CAD challenging, particularly for less experienced readers. The objective was to analyze the ability of machine learning (ML)-based CT-derived fractional flow reserve (CT-FFR) to correctly categorize cCTA studies without obstructive CAD acquired during pre-TAVI evaluation and to correlate recategorization to image quality and coronary artery calcium score (CAC). Methods : In total, 116 patients without significant stenosis (≥50% diameter) on cCTA as part of pre-TAVI CT were included. Patients were examined with an electrocardiogram-gated CT scan of the heart and high-pitch scan of the torso. Patients were re-evaluated with ML-based CT-FFR (threshold = 0.80). The standard of reference was ICA. Image quality was assessed quantitatively and qualitatively. Results : ML-based CT-FFR was successfully performed in 94.0% (109/116) of patients, including 436 vessels. With CT-FFR, 76/109 patients and 126/436 vessels were falsely categorized as having significant CAD. With CT-FFR 2/2 patients but no vessels initially falsely classified by cCTA were correctly recategorized as having significant CAD. Reclassification occurred predominantly in distal segments. Virtually no correlation was found between image quality or CAC. Conclusions : Unselectively applied, CT-FFR may vastly increase the number of false positive ratings of CAD compared to morphological scoring. Recategorization was virtually independently from image quality or CAC and occurred predominantly in distal segments. It is unclear whether or not the reduced CT-FFR represent true pressure ratios and potentially signifies pathophysiology in patients with severe aortic stenosis.
Databáze: MEDLINE
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