Coronary CT angiography derived morphological and functional quantitative plaque markers correlated with invasive fractional flow reserve for detecting hemodynamically significant stenosis

• Published in: Journal of cardiovascular computed tomography 2016-05, Vol.10 (3), p.199-206
• Main Authors: Tesche, Christian, De Cecco, Carlo N, Caruso, Damiano, Baumann, Stefan, Renker, Matthias, Mangold, Stefanie, Dyer, Kevin T, Varga-Szemes, Akos, Baquet, Moritz, Jochheim, David, Ebersberger, Ullrich, Bayer, Richard R, Hoffmann, Ellen, Steinberg, Daniel H, Schoepf, U. Joseph
• Format: Article
• Language: English
• Subjects: Aged; Area Under Curve; Cardiovascular; Computed Tomography Angiography; Coronary Angiography - methods; Coronary artery disease; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary computed tomography angiography; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - physiopathology; Coronary Vessels - diagnostic imaging; Coronary Vessels - physiopathology; Corrected coronary opacification; Female; Fractional flow reserve; Fractional Flow Reserve, Myocardial; Germany; Hemodynamics; Humans; Invasive catheter angiography; Male; Middle Aged; Plaque, Atherosclerotic; Predictive Value of Tests; Prognosis; Radiographic Image Interpretation, Computer-Assisted; Reproducibility of Results; Retrospective Studies; ROC Curve; Severity of Illness Index; Transluminal attenuation gradient; Vasodilator Agents - administration & dosage
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2016.03.002

Abstract Objective Compare morphological and functional coronary plaque markers derived from coronary CT angiography (CCTA) for their ability to detect lesion-specific ischemia. Materials and methods Data of patients who had undergone both dual-source CCTA and invasive fractional flow reserve (FFR) measurement within 3 months were retrospectively analyzed. Various quantitative stenosis markers were derived from CCTA: Corrected coronary opacification (CCO), transluminal attenuation gradient (TAG), remodeling index (RI), computational FFR (cFFR), lesion length (LL), vessel volume (VV), total plaque volume (TPV), and calcified and non-calcified plaque volume (CPV and NCPV). Discriminatory power of these markers for flow-limiting versus non-significant coronary stenosis was assessed against invasive FFR as the reference standard. Results The cohort included 37 patients (61 ± 12 years, 68% male). Among 37 lesions, 11 were hemodynamically significant by FFR. On a per-lesion level, sensitivity and specificity of TPV, CPV, and NCPV for hemodynamically significant stenosis detection were 88% and 74%, 67% and 53%, and 92% and 81%, respectively. For CCO, TAG, RI, and cFFR these were 64% and 86%, 35% and 56%, 82% and 54%, and 100% and 90%, respectively. At ROC analysis, only TPV (0.78, p  = 0.013), NCPV (0.79, p  = 0.009), cFFR (0.85, p  = 0.003), and CCO (0.82, p  = 0.0003) showed discriminatory power for detecting hemodynamically significant stenosis. Conclusion TPV, NCPV, CCO, and cFFR derived from CCTA can aid detecting hemodynamically significant coronary lesions with cFFR showing the greatest discriminatory ability.