Plaque Volume and Morphology are Associated with Fractional Flow Reserve Derived from Coronary Computed Tomography Angiography

• Published in: Journal of Atherosclerosis and Thrombosis 2019/08/01, Vol.26(8), pp.697-704
• Main Authors: Nozue, Tsuyoshi, Takamura, Takeshi, Fukui, Kazuki, Hibi, Kiyoshi, Kishi, Satoru, Michishita, Ichiro
• Format: Article
• Language: English
• Subjects: Aged; Computed Tomography Angiography - methods; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - pathology; Coronary atherosclerosis; Coronary computed tomography angiography; Coronary Vessels - diagnostic imaging; Coronary Vessels - pathology; Female; Follow-Up Studies; Fractional flow reserve; Fractional Flow Reserve, Myocardial; Humans; Male; Morphology; Original; Plaque volume; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - pathology; Prognosis; Severity of Illness Index
• ISSN: 1340-3478; 1880-3873
• DOI: 10.5551/jat.47621

Aim: Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) accurately diagnoses ischemic lesions of intermediate stenosis severity. However, significant determinants of FFRCT have not been fully evaluated.Methods: This was a sub-analysis of the Treatment of Alogliptin on Coronary Atherosclerosis Evaluated by Computed Tomography-Based Fractional Flow Reserve trial. Thirty-nine diabetic patients (117 vessels) with intermediate coronary artery stenosis [percent diameter stenosis (%DS) ＜70%] in whom FFRCT was measured were included in this study. CCTA-defined, vessel-based volumetric and morphological characteristics of plaques were examined to determine their ability to predict FFRCT.Results: Patient-based, multivariate linear regression analysis showed that hemoglobinA1c, triglycerides, and the estimated glomerular filtration rate were significant independent factors associated with FFRCT. Vessel-based, univariate linear regression analysis showed that the total atheroma volume (r=－0.233, p=0.01) and the percentage atheroma volume (PAV) (r=－0.284, p=0.002) as well as %DS (r=－0.316, p=0.006) were significant determinants of FFRCT. Among the plaque components, significant negative correlations were observed between FFRCT and low- (r=－0.248, p=0.007) or intermediate-attenuation plaque volume (r=－0.186, p=0.045), whereas calcified plaque volume was not associated with FFRCT. In the left anterior descending coronary artery (LAD), the plaque volume of each component was associated with FFRCT.Conclusions: Plaque volume, PAV, and %DS were significant determinants of FFRCT. Plaque morphology, particularly in LAD, was associated with FFRCT in diabetic patients with intermediate coronary artery stenosis.