Transluminal Attenuation Gradient in Coronary Computed Tomography Angiography Is a Novel Noninvasive Approach to the Identification of Functionally Significant Coronary Artery Stenosis

• Published in: Journal of the American College of Cardiology 2013, Vol.61 (12), p.1271-1279
• Main Authors: Wong, Dennis T.L., MBBS (Hons), Ko, Brian S., MBBS (Hons), Cameron, James D., MBBS, MD, Nerlekar, Nitesh, MBBS, Leung, Michael C.H., MBBS (Hons), PhD, Malaiapan, Yuvaraj, MBBS, Crossett, Marcus, Ba App Sc, Leong, Darryl P., MBBS (Hons), MPH, PhD, Worthley, Stephen G., MBBS, PhD, Troupis, John, MBBS, Meredith, Ian T., MBBS (Hons), PhD, Seneviratne, Sujith K., MBBS
• Format: Article
• Language: English
• Subjects: Cardiovascular; Internal Medicine
• ISSN: 0735-1097
• DOI: 10.1016/j.jacc.2012.12.029

Objective The purpose of this study was to assess the diagnostic accuracy of TAG320 in predicting functional stenosis severity evaluated by fractional flow reserve (FFR). Background Coronary computed tomography angiography (CCTA) has limited specificity for predicting functionally significant stenoses. Recent studies suggest that contrast gradient attenuation along an arterial lesion, or transluminal attenuation gradient (TAG), may provide assessment of functional significance of coronary stenosis. The use of 320-detector row computed tomography (CT), enabling near isophasic, single-beat imaging of the entire coronary tree, may be ideal for TAG functional assessment of a coronary arterial stenosis. Methods We assessed the diagnostic accuracy of TAG320 using 320-row CCTA with FFR for the evaluation of functional stenosis severity in consecutive patients undergoing invasive coronary angiography and FFR for stable chest pain. The luminal radiological contrast attenuation (Hounsfield units [HU]) was measured at 5-mm intervals along the artery from ostium to a distal level where the cross-sectional area decreased to