Coronary CT angiography derived plaque markers correlated with invasive instantaneous flow reserve for detecting hemodynamically significant coronary stenoses. Issue 122 (January 2020)

• Record Type: Journal Article
• Authors: Baumann, Stefan; Özdemir, Gökce H.; Tesche, Christian; Schoepf, U. Joseph; Golden, Joseph W.; Becher, Tobias; Hirt, Markus; Weiss, Christel; Renker, Matthias; Akin, Ibrahim; Schoenberg, Stefan O.; Borggrefe, Martin; Haubenreisser, Holger; Lossnitzer, Dirk; Overhoff, Daniel
• Is Part Of: European journal of radiology. Issue 122(2020)
• Publication Date: 2020-01
• Subjects: %APV percentage aggregate plaque volume -- ACS acute coronary syndrome -- CAD coronary artery disease -- CCO corrected coronary opacification -- cCTA coronary computed tomography angiography -- CPV calcified plaque volume -- ICA invasive coronary angiography -- iFR® instantaneous wave free ratio -- LL lesion length -- MLA minimal luminal area -- MLD minimal luminal diameter -- NCPV non-calcified plaque volume -- RI remodeling index -- SIS segment involvement score -- SSS segment stenosis score -- TPV total plaque volume -- VV vessel volume; Atherosclerosis -- Coronary artery disease -- Coronary CT angiography -- Instantaneous wave-free ratio -- Invasive coronary angiography -- Myocardial ischemia; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2019.108744
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: cCTA plaque markers can support the detection of significant coronary stenosis validated by iFR®. LL/MLD 4 shows the greatest discriminatory power. The high sensitivity of coronary plaque markers can help to reduce unnecessary ICA. Unclear cCTA findings, however, should continue to be evaluated during ICA by iFR®. Abstract: Purpose: The study aimed to compare morphological and anatomic plaque markers derived from coronary computed tomography angiography (cCTA) for the detection of lesion specific ischemia with invasive instantaneous wave free ratio (iFR®) as the reference standard. Methods: In our prospective study, we enrolled patients with suspected coronary artery disease (CAD), who had undergone cCTA, using a low-dose third-generation dual-source CT and invasive coronary angiography (ICA) with iFR® measurement. Various plaque markers were assessed on cCTA. Discriminatory power of these markers for the detection of ischemia-inducing coronary artery disease was evaluated against invasive iFR®. Results: Our study cohort included 39 patients (66.6 ± 12.0 years, 72 % male). Among 54 vessel-specific lesions, 15 lesions (28 %) were characterized as hemodynamically significant by iFR® ≤0.89. The area under the curve (AUC) of lesion length/ minimal luminal diameter 4 (LL/MLD 4 ) (0.84) was greater than the AUC of minimal luminal area (MLA) (0.82), MLD (0.81), the degree of luminal diameter stenosis (0.81), corrected coronary opacification (CCO) (0.79), remodeling index (RI) (0.75), and percentage aggregate plaque volume (%APV) (0.72). LL, vessel volume (VV), total plaque volume (TPV), calcified and non-calcified plaque volume (CPV and NCPV) did not reach statistical significance and were unable to discriminate between vessels with and without ischemia-inducing coronary stenosis. Conclusion: LL/MLD 4, MLA, MLD, the degree of luminal diameter stenosis, CCO, RI, and %APV derived from cCTA can support the detection of hemodynamically significant coronary stenosis as compared with iFR®, with LL/MLD 4 showing the greatest discriminatory power.