Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses.

Abstract

PURPOSE:

The study aimed to compare morphological and anatomic plaque markers derived from coronary computed tomography angiography (cCTA) for the detection of lesion specific ischemia with invasive instantaneous wave free ratio (iFR®) as the reference standard.

METHODS:

In our prospective study, we enrolled patients with suspected coronary artery disease (CAD), who had undergone cCTA, using a low-dose third-generation dual-source CT and invasive coronary angiography (ICA) with iFR® measurement. Various plaque markers were assessed on cCTA. Discriminatory power of these markers for the detection of ischemia-inducing coronary artery disease was evaluated against invasive iFR®.

RESULTS:

Our study cohort included 39 patients (66.6 ± 12.0 years, 72 % male). Among 54 vessel-specific lesions, 15 lesions (28 %) were characterized as hemodynamically significant by iFR® ≤0.89. The area under the curve (AUC) of lesion length/ minimal luminal diameter4 (LL/MLD4) (0.84) was greater than the AUC of minimal luminal area (MLA) (0.82), MLD (0.81), the degree of luminal diameter stenosis (0.81), corrected coronary opacification (CCO) (0.79), remodeling index (RI) (0.75), and percentage aggregate plaque volume (%APV) (0.72). LL, vessel volume (VV), total plaque volume (TPV), calcified and non-calcified plaque volume (CPV and NCPV) did not reach statistical significance and were unable to discriminate between vessels with and without ischemia-inducing coronary stenosis.

CONCLUSION:

LL/MLD4, MLA, MLD, the degree of luminal diameter stenosis, CCO, RI, and %APV derived from cCTA can support the detection of hemodynamically significant coronary stenosis as compared with iFR®, with LL/MLD4 showing the greatest discriminatory power.

• Authors: Stefan Baumann, Gökce H Özdemir, Christian Tesche, U Joseph Schoepf, Joseph W Golden, Tobias Becher, Markus Hirt, Christel Weiss, Matthias Renker, Ibrahim Akin, Stefan O Schoenberg, Martin Borggrefe, Holger Haubenreisser, Dirk Lossnitzer, Daniel Overhoff
• Journal: European journal of radiology (Eur J Radiol) Vol. 122 Pg. 108744 (Jan 2020) ISSN: 1872-7727 [Electronic] Ireland
• PMID: 31790934 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Chemical References

• Biomarkers

Topics

• Aged
• Area Under Curve
• Biomarkers (metabolism)
• Computed Tomography Angiography (methods)
• Coronary Angiography (methods)
• Coronary Artery Disease (diagnostic imaging, physiopathology)
• Coronary Stenosis (diagnostic imaging, physiopathology)
• Female
• Fractional Flow Reserve, Myocardial (physiology)
• Hemodynamics (physiology)
• Humans
• Male
• Middle Aged
• Plaque, Atherosclerotic (diagnostic imaging, physiopathology)
• Prospective Studies
• Retrospective Studies
• Tomography, X-Ray Computed (methods)