CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris

Autor: Brian Ko, Sara Gaur, Stephan Achenbach, Bjarne L. Nørgaard, Damini Dey, Hans Erik Bøtker, Jesper M. Jensen, Kristian A. Øvrehus, Jonathon Leipsic, Amir Ahmadi
Jazyk: angličtina
Rok vydání: 2018
Předmět:
Male
Cardiac Catheterization
Computed Tomography Angiography
Hemodynamics
Coronary Vessels/diagnostic imaging
Coronary Artery Disease
Fractional flow reserve
030204 cardiovascular system & hematology
Coronary Angiography
Severity of Illness Index
030218 nuclear medicine & medical imaging
Coronary artery disease
0302 clinical medicine
Prospective Studies
Middle Aged
Prognosis
Coronary Vessels
Plaque
Atherosclerotic
Fractional Flow Reserve
Myocardial
Area Under Curve
Cardiology
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Coronary Artery Disease/diagnostic imaging
medicine.medical_specialty
Ischemia
Lesion
03 medical and health sciences
Predictive Value of Tests
Internal medicine
Multidetector Computed Tomography
medicine
Humans
Radiology
Nuclear Medicine and imaging
In patient
Angina
Stable
Aged
Coronary Angiography/methods
Chi-Square Distribution
Receiver operating characteristic
business.industry
Coronary Stenosis
Reproducibility of Results
Angina
Stable/diagnostic imaging
medicine.disease
Coronary Stenosis/diagnostic imaging
Stenosis
Logistic Models
ROC Curve
Linear Models
business
Zdroj: Øvrehus, K A, Gaur, S, Leipsic, J, Jensen, J M, Dey, D, Bøtker, H E, Ahmadi, A, Achenbach, S, Ko, B & Nørgaard, B L 2018, ' CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris ', Journal of Cardiovascular Computed Tomography, vol. 12, no. 4, pp. 344–349 . https://doi.org/10.1016/j.jcct.2018.04.008
Øvrehus, K A, Gaur, S, Leipsic, J, Jensen, J M, Dey, D, Bøtker, H E, Ahmadi, A, Achenbach, S, Ko, B & Nørgaard, B L 2018, ' CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris ', Journal of Cardiovascular Computed Tomography, vol. 12, no. 4, pp. 344-349 . https://doi.org/10.1016/j.jcct.2018.04.008
DOI: 10.1016/j.jcct.2018.04.008
Popis: BACKGROUND: Coronary stenosis and plaque evaluation by coronary computed tomography angiography (CTA) may contribute to identify hemodynamically relevant lesions. We evaluated the most stenotic lesion including plaques proximal to it versus a total vessel analyses combined with stenosis for ischemia.METHODS: Patients scheduled for clinically indicated invasive coronary angiography (ICA) for suspected coronary artery disease underwent coronary CTA and ICA including fractional flow reserve (FFR) as part of the NXT trial (clinicaltrials.govNCT01757678). Stenoses were visually graded ≤50%, 51-70%, and >70% on coronary CTA. Semi-automated plaque analyses were performed using a proximal to the FFR pressure sensor location (including the most severe lesion to the coronary ostium) versus a total vessel (vessel diameter ≥2 mm) approach. Coronary stenosis and plaque parameters were evaluated for discrimination of ischemia by logistic regressions and combined models analyzed using receiver operating characteristics (ROC) with invasive FFR≤ 0.80 as reference standard.RESULTS: In 254 patients, mean (±SD) age 64 (±10) years, 64% male, a coronary CTA stenosis >50% was present in 239 (49%) vessels. Invasive FFR was ≤0.80 in 100 (21%) vessels. Coronary stenosis severity and low-density non-calcified plaque (LD-NCP) volume were independent predictors of ischemia in the "proximal" and "total-vessel" analyses. Stenosis severity + total vessel LD-NCP assessment performed better than stenosis severity + proximal LD-NCP evaluation (Area under curve [AUC] (95%CI): 0.83 (0.78-0.87) vs 0.81 (0.76-0.86), p-value = 0.009), whereas stenosis severity + proximal LD-NCP performed better than stenosis alone (AUC (95%CI): 0.81 (0.76-0.86) vs 0.78 (0.73-0.83), p-value = 0.019).CONCLUSION: Adding total vessel high-risk plaque volume to stenosis severity improves discrimination of ischemia in coronary CTA performed in patients with stable angina pectoris.
Databáze: OpenAIRE
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