Coronary computed tomography angiography derived fractional flow reserve and risk of recurrent angina: A 3-year follow-up study.

Autor: Madsen KT; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark. Electronic address: kristian.taekker.madsen2@rsyd.dk., Nørgaard BL; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Øvrehus KA; Department of Cardiology, Odense University Hospital, Odense, Denmark., Jensen JM; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Parner E; Department of Public Health, Section for Biostatistics, Aarhus University, Denmark., Grove EL; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark., Mortensen MB; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Fairbairn TA; Department of Cardiology, Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom., Nieman K; Departments of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA., Patel MR; Division of Cardiology, Department of Medicine, Duke University, Durham, NC, USA., Rogers C; HeartFlow Inc., Mountain View, CA, USA., Mullen S; HeartFlow Inc., Mountain View, CA, USA., Mickley H; Department of Cardiology, Odense University Hospital, Odense, Denmark., Thomsen KK; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark., Bøtker HE; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark., Leipsic J; Department of Radiology, Providence Health Care, St. Paul's Hospital, University of British Columbia, Vancouver, Canada., Sand NPR; Department of Cardiology, University Hospital of Southern Denmark, Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Esbjerg, Denmark.
Jazyk: angličtina
Zdroj: Journal of cardiovascular computed tomography [J Cardiovasc Comput Tomogr] 2024 May-Jun; Vol. 18 (3), pp. 243-250. Date of Electronic Publication: 2024 Jan 20.
DOI: 10.1016/j.jcct.2024.01.010
Abstrakt: Background: The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFR CT ) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain.
Methods: Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 ​% coronary stenosis. A per-patient lowest FFR CT -value ≤0.80 represented an abnormal test result. Patients with FFR CT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFR CT ), all vessels with FFR CT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFR CT ) ≥1 vessels with FFR CT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire.
Results: Amongst 769 patients (619 [80 ​%] stenosis ≥50 ​%, 510 [66 ​%] FFR CT ≤0.80), 174 (23 ​%) reported recurrent angina at follow-up. An FFR CT ≤0.80 vs ​> ​0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 ​% CI: 1.31-2.52, p ​< ​0.001. Risk of recurrent angina in CR-FFR CT (n ​= ​135) was similar to patients with FFR CT >0.80, 13 ​% vs 15 ​%, RR: 0.93; 95 ​% CI: 0.62-1.40, p ​= ​0.72, while IR-FFR CT (n ​= ​90) and non-revascularized patients with FFR CT ≤0.80 (n ​= ​285) had increased risk, 37 ​% vs 15 ​% RR: 2.50; 95 ​% CI: 1.68-3.73, p ​< ​0.001 and 30 ​% vs 15 ​%, RR: 2.03; 95 ​% CI: 1.44-2.87, p ​< ​0.001, respectively. Use of antianginal medication was similar across study groups.
Conclusion: In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFR CT provides information regarding risk of recurrent angina.
Competing Interests: Declaration of competing interest CR is a full-time employee of HeartFlow, and receives salary and stock options from HeartFlow. ELG has no conflicts related to this manuscript but has received speaker honoraria or consultancy fees from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Pfizer, MSD, Lundbeck Pharma and Organon. He is investigator in clinical studies sponsored by AstraZeneca or Bayer and has received unrestricted research grants from Boehringer Ingelheim. JL is a consultant and holds stock options in Circle CVI and HeartFlow. KN acknowledges support from the NIH and reports unrestricted institutional research support from Siemens Healthineers, Bayer, HeartFlow Inc and Novartis. MP has received research grants from Janssen, Bayer, Heartflow and NIH and is part of the following advisory boards: Janssen, Bayer, Heartflow, Phillips. SM is a full-time employee of HeartFlow, and shareholder of HeartFlow. TF is associated with the HeartFlow speakers bureau. All other authors had no disclosures to declare.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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