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Diffuse coronary artery disease among other atherosclerotic plaque characteristics by coronary computed tomography angiography for predicting coronary vessel-specific ischemia by fractional flow reserve.
Atherosclerosis. 2017 03; 258:145-151.A

Abstract

BACKGROUND AND AIMS

Coronary computed tomography angiography (CCTA) permits effective identification of diffuse CAD and atherosclerotic plaque characteristics (APCs). We sought to examine the usefulness of diffuse CAD beyond luminal narrowing and APCs by CCTA to detect vessel-specific ischemia.

METHODS

407 vessels (n = 252 patients) from the DeFACTO diagnostic accuracy study were retrospectively analyzed for percent plaque diffuseness (PD). Percent plaque diffuseness (PD) was obtained on per-vessel level by summation of all contiguous lesion lengths and divided by total vessel length, and was logarithmically transformed (log percent PD). Additional CCTA measures of stenosis severity including minimal lumen diameter (MLD), and APCs, such as positive remodeling (PR) and low attenuation plaque (LAP), were also included. Vessel-specific ischemia was defined as fractional flow reserve (FFR) ≤0.80. Multivariable regression, discrimination by area under the receiver operating characteristic curve (AUC), and category-free net reclassification improvement (cNRI) were assessed.

RESULTS

Backward stepwise logistic regression revealed that for every unit increase in log percent PD, there was a 58% (95% CI: 1.01-2.48, p = 0.048) rise in the odds of having an abnormal FFR, independent of stenosis severity and APCs. The AUC indicated no further improvement in discriminatory ability after adding log percent PD to the final parsimonious model of MLD, PR, and LAP (AUC difference: 0.003, 95% CI: -0.003-0.010, p = 0.33). Conversely, adding log percent PD to the base model of MLD, PR, and LAP improved cNRI by 0.21 (95% CI: 0.01-0.41, p < 0.001).

CONCLUSIONS

Accounting for diffuse CAD may help improve the accuracy of CCTA for detecting vessel-specific ischemia.

Authors+Show Affiliations

Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States; Departments of Radiology and Medicine, Weill Cornell Medicine, New York, NY, United States.Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States; Departments of Radiology and Medicine, Weill Cornell Medicine, New York, NY, United States. Electronic address: jkm2001@med.cornell.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28168977

Citation

Rizvi, Asim, et al. "Diffuse Coronary Artery Disease Among Other Atherosclerotic Plaque Characteristics By Coronary Computed Tomography Angiography for Predicting Coronary Vessel-specific Ischemia By Fractional Flow Reserve." Atherosclerosis, vol. 258, 2017, pp. 145-151.
Rizvi A, Hartaigh BÓ, Danad I, et al. Diffuse coronary artery disease among other atherosclerotic plaque characteristics by coronary computed tomography angiography for predicting coronary vessel-specific ischemia by fractional flow reserve. Atherosclerosis. 2017;258:145-151.
Rizvi, A., Hartaigh, B. Ó., Danad, I., Han, D., Lee, J. H., Gransar, H., Szymonifka, J., Lin, F. Y., & Min, J. K. (2017). Diffuse coronary artery disease among other atherosclerotic plaque characteristics by coronary computed tomography angiography for predicting coronary vessel-specific ischemia by fractional flow reserve. Atherosclerosis, 258, 145-151. https://doi.org/10.1016/j.atherosclerosis.2017.01.018
Rizvi A, et al. Diffuse Coronary Artery Disease Among Other Atherosclerotic Plaque Characteristics By Coronary Computed Tomography Angiography for Predicting Coronary Vessel-specific Ischemia By Fractional Flow Reserve. Atherosclerosis. 2017;258:145-151. PubMed PMID: 28168977.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diffuse coronary artery disease among other atherosclerotic plaque characteristics by coronary computed tomography angiography for predicting coronary vessel-specific ischemia by fractional flow reserve. AU - Rizvi,Asim, AU - Hartaigh,Bríain Ó, AU - Danad,Ibrahim, AU - Han,Donghee, AU - Lee,Ji Hyun, AU - Gransar,Heidi, AU - Szymonifka,Jackie, AU - Lin,Fay Y, AU - Min,James K, Y1 - 2017/01/16/ PY - 2016/09/23/received PY - 2016/12/30/revised PY - 2017/01/13/accepted PY - 2017/2/9/pubmed PY - 2017/11/29/medline PY - 2017/2/8/entrez KW - Atherosclerotic plaque characteristics KW - Coronary computed tomography angiography KW - Diffuse coronary artery disease KW - Fractional flow reserve KW - Stenosis severity SP - 145 EP - 151 JF - Atherosclerosis JO - Atherosclerosis VL - 258 N2 - BACKGROUND AND AIMS: Coronary computed tomography angiography (CCTA) permits effective identification of diffuse CAD and atherosclerotic plaque characteristics (APCs). We sought to examine the usefulness of diffuse CAD beyond luminal narrowing and APCs by CCTA to detect vessel-specific ischemia. METHODS: 407 vessels (n = 252 patients) from the DeFACTO diagnostic accuracy study were retrospectively analyzed for percent plaque diffuseness (PD). Percent plaque diffuseness (PD) was obtained on per-vessel level by summation of all contiguous lesion lengths and divided by total vessel length, and was logarithmically transformed (log percent PD). Additional CCTA measures of stenosis severity including minimal lumen diameter (MLD), and APCs, such as positive remodeling (PR) and low attenuation plaque (LAP), were also included. Vessel-specific ischemia was defined as fractional flow reserve (FFR) ≤0.80. Multivariable regression, discrimination by area under the receiver operating characteristic curve (AUC), and category-free net reclassification improvement (cNRI) were assessed. RESULTS: Backward stepwise logistic regression revealed that for every unit increase in log percent PD, there was a 58% (95% CI: 1.01-2.48, p = 0.048) rise in the odds of having an abnormal FFR, independent of stenosis severity and APCs. The AUC indicated no further improvement in discriminatory ability after adding log percent PD to the final parsimonious model of MLD, PR, and LAP (AUC difference: 0.003, 95% CI: -0.003-0.010, p = 0.33). Conversely, adding log percent PD to the base model of MLD, PR, and LAP improved cNRI by 0.21 (95% CI: 0.01-0.41, p < 0.001). CONCLUSIONS: Accounting for diffuse CAD may help improve the accuracy of CCTA for detecting vessel-specific ischemia. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/28168977/Diffuse_coronary_artery_disease_among_other_atherosclerotic_plaque_characteristics_by_coronary_computed_tomography_angiography_for_predicting_coronary_vessel_specific_ischemia_by_fractional_flow_reserve_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(17)30020-5 DB - PRIME DP - Unbound Medicine ER -