Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve.

Autor: Nozaki YO; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Fujimoto S; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. Electronic address: s-fujimo@tj8.so-net.ne.jp., Kawaguchi YO; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Aoshima C; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Kamo Y; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Sato H; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Radiological Technology, Juntendo University Hospital, Tokyo, Japan., Kudo H; Department of Radiological Technology, Juntendo University Hospital, Tokyo, Japan., Takamura K; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Kudo A; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Takahashi D; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Hiki M; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Dohi T; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan., Tomizawa N; Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan., Kumamaru KK; Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan., Aoki S; Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan., Minamino T; Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan.
Jazyk: angličtina
Zdroj: Journal of cardiology [J Cardiol] 2022 Jul; Vol. 80 (1), pp. 14-21. Date of Electronic Publication: 2022 Mar 29.
DOI: 10.1016/j.jjcc.2022.02.019
Abstrakt: Background: On-site computed tomography-derived fractional flow reserve (CT-FFR), using fluid structure interaction during multiple optimal diastolic phases, is of incremental diagnostic value. However, few studies have investigated prognosis, with the appropriate measurement location of CT-FFR, as a stand-alone modality. The aim of the present study was to assess the clinical impact on CT-FFR with an appropriate measurement.
Methods: A total of 370 consecutive patients (68 ± 10 years, 75% male) who underwent coronary CT angiography (CCTA), showing 50-90% stenosis in at least one major epicardial vessel, were retrospectively analyzed and followed up for a median 2.9 years. CT-FFR values were measured at three points: 1 to 2 cm distal to the target lesion (CT-FFR 1cm, 2cm ) and the vessel terminus (CT-FFR lowest ), and a CT-FFR value ≤0.80 was considered to be abnormal. The endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction, and unplanned revascularization.
Results: The incidence of MACE was 6.8% (25/370 patients). The Kaplan-Meier survival analysis in negative CT-FFR 1/2cm revealed no significant difference in MACE between negative and positive CT-FFR lowest [p = 0.11/0.23 (1/2 cm vs lowest)]. Among 221 patients who did not undergo planned revascularization within 90 days of CCTA, no significant differences were noted in the incidence of MACE between negative and positive CT-FFR lowest (p = 0.11). In contrast, the risk of MACE was significantly higher with positive CT-FFR 1/2cm [p = 0.0198/0.0002 (1/2 cm)].
Conclusions: In terms of the prognosis of patients with moderate to severe stenosis on CCTA, CT-FFR measured 1 to 2 cm distal to the target lesion may be feasible for the safe deferral of unnecessary invasive coronary angiography. Moreover, CT-FFR 1/2cm showed better risk stratification than CT-FFR lowest based on future adverse cardiac events.
Competing Interests: Declaration of competing interest Dr. Fujimoto has a research agreement with Canon Medical Systems Corporation that is related to this study. All other authors report no conflicts of interest to the work.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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