Comparison of quantitative stenosis characteristics at routine coronary computed tomography angiography with invasive fractional flow reserve for assessing lesion-specific ischemia

• Published in: Journal of cardiovascular computed tomography Vol. 9; no. 6; pp. 546 - 552
• Main Authors: Wang, Rui, MD, Baumann, Stefan, MD, Schoepf, U. Joseph, MD, Meinel, Felix G., MD, Rier, Jeremy D., DO, Morris, Justin Z., BS, Möllmann, Helge, MD, Hamm, Christian W., MD, Steinberg, Daniel H., MD, Renker, Matthias, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2015
• Subjects: Aged; Area Under Curve; Cardiac Catheterization; Cardiovascular; Coronary Angiography - methods; Coronary artery disease; Coronary CT angiography; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - etiology; Coronary Stenosis - physiopathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Female; Fractional flow reserve; Fractional Flow Reserve, Myocardial; Humans; Invasive coronary angiography; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Tomography, X-Ray Computed; area under the receiver operating characteristic curve; cCTA; MLA; minimal luminal area; CAD; APV; percentage aggregate plaque volume; Coronary artery disease; Invasive coronary angiography; Fractional flow reserve; LL/MLD 4; CCO; AUC; FFR; lesion length/minimal lesion diameter 4; corrected coronary opacification; Coronary CT angiography; LL/MLD4
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2015.08.003

Abstract Objective To comprehensively evaluate quantitative parameters derived from routine coronary CT angiography (cCTA) for predicting lesion-specific ischemia in comparison to invasive fractional flow reserve (FFR). Background The ability of cCTA to gauge lesion-specific ischemia is limited. Several quantitative parameters have been proposed to enhance the specificity of cCTA, such as morphologic indices (lesion length/minimal lumen diameter4 [LL/MLD4 ]; percentage aggregate plaque volume [%APV]) and a measure of intracoronary contrast gradients (corrected coronary opacification [CCO]). Methods Forty-nine patients who had undergone cCTA followed by FFR within 3 months were included. An experienced observer visually assessed all cCTA studies and derived multiple measures characterizing the lesion of interest, including LL, MLD, minimal lumen area (MLA), LL/MLD4 , remodeling index, %APV, and CCO. Lesion-specific ischemia was considered with FFR <0.8. Results Among 56 lesions, 13 were flow-obstructing by FFR. On univariate analysis, LL, MLD, LL/MLD4 , and CCO showed discriminatory power. The area under the curve of LL/MLD4 (0.909) was significantly greater compared with MLD (0.802, P  = 0.014), LL (0.739, P  = 0.041), and CCO (0.809), although the latter did not reach statistical significance ( P  = 0.175). On multivariate regression, LL/MLD4 was the only independent predictor of lesion-specific ischemia (odds ratio 2.021, P  = 0.001). Moreover, LL/MLD4 compared favorably to visual cCTA evaluation. Conclusion LL/MLD4 derived from routine cCTA can enhance the detection of lesion-specific ischemia and may be superior to other described quantitative parameters.