Plaque characteristics on coronary CT angiography associated with the positive findings of fractional flow reserve and instantaneous wave-free ratio

• Published in: Heart and vessels 2021-04, Vol.36 (4), p.461-471
• Main Authors: Aoshima, Chihiro, Fujimoto, Shinichiro, Kawaguchi, Yuko O., Dohi, Tomotaka, Kamo, Yuki, Takamura, Kazuhisa, Hiki, Makoto, Kato, Yoshiteru, Okai, Iwao, Okazaki, Shinya, Kumamaru, Kanako K., Aoki, Shigeki, Daida, Hiroyuki
• Format: Article
• Language: English
• Subjects: Angiography; Biomedical Engineering and Bioengineering; Blood vessels; Cardiac Surgery; Cardiology; Cardiovascular disease; Coronary artery; Coronary artery disease; Discordance; Heart diseases; Medical imaging; Medicine; Medicine & Public Health; Original Article; Regression analysis; Stenosis; Vascular Surgery
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-020-01722-w

Background Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are useful in determining indications for revascularization of coronary artery disease (CAD). Although the discordance of FFR and iFR was noted in approximately 20%, this cause has not been well established. We investigated patient background and features on coronary CT angiography (CCTA) showing not only FFR- and iFR-positive findings but also discordance between FFR ≤ 0.8 and iFR ≤ 0.89. Methods Subjects were consecutively treated in 83 cases with 105 vessels in which stenosis of 30–90% was detected at one vessel of at least 2 mm or more in the major epicardial vessels and FFR and iFR was performed within subsequent 90 days, among suspected CAD which underwent CCTA. The factors affecting not only FFR- and iFR-positive findings, respectively, but also discordance between FFR and iFR was evaluated using logistic regression analysis on per-patient and per-vessel basis. Results FFR- and iFR-positive findings were observed in 42 vessels (40.0%) and 34 vessels (32.3%), respectively. Discordance between FFR ≤ 0.8 and iFR ≤ 0.89 was observed in 22 vessels (21.0%) of 21 patients. In multivariate logistic analysis, LAD (OR 3.55; 95%CI 1.20–11.71; p  = 0.0217) and lumen volume/myocardial weight ( L / M ) ratio (OR 0.93; 0.86–0.99, p  = 0.0290) were significant predictors for FFR-positive findings. For iFR-positive findings, LAD (OR 3.86; 95%CI 1.12–13.31; p  = 0.0236) was only significant predictor. In FFR ≤ 0.8 and iFR > 0.89 group (15 vessels, 14.3%), positive remodeling (PR) (OR 5.03, 95%CI 1.23–20.48, p  = 0.0205) was significant predictor. In FFR > 0.8 and iFR ≤ 0.89 group (7 vessels, 6.7%), there were no significant predictors. Conclusion On CCTA characteristics, a relevant predictor for FFR-positive findings included low L / M ratio. PR was significant predictor in FFR-positive, iFR-negative patients among those with discordance between the FFR and iFR.