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CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris.
J Cardiovasc Comput Tomogr. 2018 Jul - Aug; 12(4):344-349.JC

Abstract

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.

Authors+Show Affiliations

Department of Cardiology, Odense University Hospital, Odense, Denmark. Electronic address: kristian.altern.ovrehus@rsyd.dk.Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada.Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.Cedars-Sinai Medical Center, Los Angeles, CA, USA.Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.Icahn School of Medicine at Mount Sinai, New York, NY, USA.Department of Cardiology, Friedrich-Alexander University of Erlangen, Germany.Monash Heart, Monash Medical Center and Monash University, Victoria, Australia.Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

29866619

Citation

Øvrehus, Kristian A., et al. "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, 2018, pp. 344-349.
Øvrehus KA, Gaur S, Leipsic J, et al. CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris. J Cardiovasc Comput Tomogr. 2018;12(4):344-349.
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, 12(4), 344-349. https://doi.org/10.1016/j.jcct.2018.04.008
Øvrehus KA, et al. CT-based Total Vessel Plaque Analyses Improves Prediction of Hemodynamic Significance Lesions as Assessed By Fractional Flow Reserve in Patients With Stable Angina Pectoris. J Cardiovasc Comput Tomogr. 2018 Jul - Aug;12(4):344-349. PubMed PMID: 29866619.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - CT-based total vessel plaque analyses improves prediction of hemodynamic significance lesions as assessed by fractional flow reserve in patients with stable angina pectoris. AU - Øvrehus,Kristian A, AU - Gaur,Sara, AU - Leipsic,Jonathon, AU - Jensen,Jesper M, AU - Dey,Damini, AU - Bøtker,Hans E, AU - Ahmadi,Amir, AU - Achenbach,Stephan, AU - Ko,Brian, AU - Nørgaard,Bjarne L, Y1 - 2018/05/08/ PY - 2017/10/16/received PY - 2018/04/14/revised PY - 2018/04/26/accepted PY - 2018/6/6/pubmed PY - 2018/11/6/medline PY - 2018/6/6/entrez KW - Coronary computed tomography angiography KW - Coronary plaque assessment KW - Coronary stenosis KW - Fractional flow reserve SP - 344 EP - 349 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 12 IS - 4 N2 - 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. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/29866619/CT_based_total_vessel_plaque_analyses_improves_prediction_of_hemodynamic_significance_lesions_as_assessed_by_fractional_flow_reserve_in_patients_with_stable_angina_pectoris_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(18)30082-0 DB - PRIME DP - Unbound Medicine ER -