Tags

Type your tag names separated by a space and hit enter

Non-invasive fractional flow reserve in vessels without severe obstructive stenosis is associated with coronary plaque burden.
J Cardiovasc Comput Tomogr. 2018 Sep - Oct; 12(5):379-384.JC

Abstract

AIMS

Non-invasive fractional flow reserve derived from coronary CT angiography (FFRCT) has been shown to be predictive of lesion-specific ischemia as assessed by invasive fractional flow reserve (FFR). However, in practice, clinicians are often faced with an abnormal distal FFRCT in the absence of a discrete obstructive lesion. Using quantitative plaque analysis, we sought to determine the relationship between an abnormal whole vessel FFRCT (V-FFRCT) and quantitative measures of whole vessel atherosclerosis in coronary arteries without obstructive stenosis.

METHODS

FFRCT was calculated in 155 consecutive patients undergoing coronary CTA with ≥25% but less than 70% stenosis in at least one major epicardial vessel. Semi-automated software was used to quantify plaque volumes (total plaque [TP], calcified plaque [CP], non-calcified plaque [NCP], low-density non-calcified plaque [LD-NCP]), remodeling index [RI], maximal contrast density difference [CDD] and percent diameter stenosis [%DS]. Abnormal V-FFRCT was defined as a minimum value of ≤0.75 across the vessel (at the most distal region where FFRCT was computed).

RESULTS

Vessels with abnormal V-FFRCT had higher per-vessel TP (554 vs 331 mm3), CP (59 vs 25 mm3), NCP (429 vs 295 mm3), LD-NCP (65 vs 35 mm3) volume and maximum CDD (21 vs 14%) than those with normal V-FFRCT (median, p < 0.05 for all). Using a multivariate analysis to adjust for CDD and %DS, all measures of plaque volume were predictive of abnormal V-FFRCT (OR 2.09, 1.36, 1.95, 1.95 for TP, CP, NCP and LD-NCP volume, respectively; p < 0.05 for all).

CONCLUSION

Abnormal V-FFRCT in vessels without obstructive stenosis is associated with multiple markers of diffuse non-obstructive atherosclerosis, independent of stenosis severity. Whole vessel FFRCT may represent a novel measure of diffuse coronary plaque burden.

Authors+Show Affiliations

Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Centre for Cardiovascular Science, University of Edinburgh, Scotland, UK. Electronic address: Mhairi.Doris@ed.ac.uk.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Yuka.Otaki@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Yoav.Arnson@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Balaji.Tamarappoo@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: markus.goeller@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Heidi.Gransar@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Frances.Wang@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Sean.Hayes@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: John.Friedman@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Louise.Thomson@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Piotr.Slomka@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Damini.Dey@cshs.org.Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: Daniel.Berman@cshs.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29784622

Citation

Doris, Mhairi K., et al. "Non-invasive Fractional Flow Reserve in Vessels Without Severe Obstructive Stenosis Is Associated With Coronary Plaque Burden." Journal of Cardiovascular Computed Tomography, vol. 12, no. 5, 2018, pp. 379-384.
Doris MK, Otaki Y, Arnson Y, et al. Non-invasive fractional flow reserve in vessels without severe obstructive stenosis is associated with coronary plaque burden. J Cardiovasc Comput Tomogr. 2018;12(5):379-384.
Doris, M. K., Otaki, Y., Arnson, Y., Tamarappoo, B., Goeller, M., Gransar, H., Wang, F., Hayes, S., Friedman, J., Thomson, L., Slomka, P., Dey, D., & Berman, D. (2018). Non-invasive fractional flow reserve in vessels without severe obstructive stenosis is associated with coronary plaque burden. Journal of Cardiovascular Computed Tomography, 12(5), 379-384. https://doi.org/10.1016/j.jcct.2018.05.003
Doris MK, et al. Non-invasive Fractional Flow Reserve in Vessels Without Severe Obstructive Stenosis Is Associated With Coronary Plaque Burden. J Cardiovasc Comput Tomogr. 2018 Sep - Oct;12(5):379-384. PubMed PMID: 29784622.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Non-invasive fractional flow reserve in vessels without severe obstructive stenosis is associated with coronary plaque burden. AU - Doris,Mhairi K, AU - Otaki,Yuka, AU - Arnson,Yoav, AU - Tamarappoo,Balaji, AU - Goeller,Markus, AU - Gransar,Heidi, AU - Wang,Frances, AU - Hayes,Sean, AU - Friedman,John, AU - Thomson,Louise, AU - Slomka,Piotr, AU - Dey,Damini, AU - Berman,Daniel, Y1 - 2018/05/07/ PY - 2018/02/15/received PY - 2018/04/13/revised PY - 2018/05/03/accepted PY - 2018/5/23/pubmed PY - 2018/11/27/medline PY - 2018/5/23/entrez KW - Diffuse atherosclerosis KW - Fractional flow reserve KW - Plaque characteristics SP - 379 EP - 384 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 12 IS - 5 N2 - AIMS: Non-invasive fractional flow reserve derived from coronary CT angiography (FFRCT) has been shown to be predictive of lesion-specific ischemia as assessed by invasive fractional flow reserve (FFR). However, in practice, clinicians are often faced with an abnormal distal FFRCT in the absence of a discrete obstructive lesion. Using quantitative plaque analysis, we sought to determine the relationship between an abnormal whole vessel FFRCT (V-FFRCT) and quantitative measures of whole vessel atherosclerosis in coronary arteries without obstructive stenosis. METHODS: FFRCT was calculated in 155 consecutive patients undergoing coronary CTA with ≥25% but less than 70% stenosis in at least one major epicardial vessel. Semi-automated software was used to quantify plaque volumes (total plaque [TP], calcified plaque [CP], non-calcified plaque [NCP], low-density non-calcified plaque [LD-NCP]), remodeling index [RI], maximal contrast density difference [CDD] and percent diameter stenosis [%DS]. Abnormal V-FFRCT was defined as a minimum value of ≤0.75 across the vessel (at the most distal region where FFRCT was computed). RESULTS: Vessels with abnormal V-FFRCT had higher per-vessel TP (554 vs 331 mm3), CP (59 vs 25 mm3), NCP (429 vs 295 mm3), LD-NCP (65 vs 35 mm3) volume and maximum CDD (21 vs 14%) than those with normal V-FFRCT (median, p < 0.05 for all). Using a multivariate analysis to adjust for CDD and %DS, all measures of plaque volume were predictive of abnormal V-FFRCT (OR 2.09, 1.36, 1.95, 1.95 for TP, CP, NCP and LD-NCP volume, respectively; p < 0.05 for all). CONCLUSION: Abnormal V-FFRCT in vessels without obstructive stenosis is associated with multiple markers of diffuse non-obstructive atherosclerosis, independent of stenosis severity. Whole vessel FFRCT may represent a novel measure of diffuse coronary plaque burden. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/29784622/Non_invasive_fractional_flow_reserve_in_vessels_without_severe_obstructive_stenosis_is_associated_with_coronary_plaque_burden_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(18)30095-9 DB - PRIME DP - Unbound Medicine ER -