Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease. (15th May 2022)

• Record Type: Journal Article
• Authors: Tsugu, Toshimitsu; Tanaka, Kaoru; Belsack, Dries; Devos, Hannes; Nagatomo, Yuji; Michiels, Vincent; Argacha, Jean-François; Cosyns, Bernard; Buls, Nico; De Maeseneer, Michel; De Mey, Johan
• Is Part Of: International journal of cardiology. Volume 355(2022)
• Page Start: 59
• Page End: 64
• Publication Date: 2022-05-15
• Subjects: FFRCT -- Underestimation -- False negative -- Coronary microvascular dysfunction -- Plaque components; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.03.005
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: In significant obstructive coronary artery disease (SOCAD), a mismatch in assessment of severity of coronary artery stenosis may occur between invasive coronary angiography (ICA) and computed tomography (CT) derived fractional flow reserve (FFRCT ). The present study aimed to identify the factors giving an FFRCT > 0.80 and leading to an underestimation of coronary artery severity in SOCAD vessels. Methods: A total of 141 consecutive patients who underwent both CT angiography including FFRCT and ICA, the latter showing >75% coronary artery stenosis were evaluated. Vessels were divided into two groups according to FFRCT at the distal aspect of the vessel: FFRCT > 0.80 (n = 12) and FFRCT ≤ 0.80 (n = 153). Vessel morphology, plaque characteristics, left-ventricular (LV) wall thickness at each site of the myocardium, and LV mass were also assessed. Results: LV myocardium-related parameters including LV wall thickness (base, middle, apex, average, and maximal), LV mass, and LV mass index were higher in FFRCT > 0.80, whereas vessel-related parameters including, vessel morphology and plaque characteristics were not significantly different between >0.80 and < 0.80. Vessel morphology and plaque characteristics had no effect on FFRCT, whereas maximum LV wall thickness, LV mass, and LV mass index influenced FFRCT . LV mass index was the strongest predictor of distal FFRCT > 0.80 with an area under the curve of 0.81, and an optimal cut-off value of 66.5 g/m 2 (sensitivity 77.8%, specificity 89.6%). Conclusions: The presence of a high LV mass is a major cause for underestimation of coronary artery severity on FFRCT in SOCAD vessels. LV myocardium-related parameters should be considered when interpreting numerical values of FFRCT . Graphical abstract: Unlabelled Image Highlights: All levels of LV wall-thickness were higher in FFRCT > 0.80 than FFRCT ≤ 0.80. Vessel-related and plaque characteristics parameters were not related to FFRCT . Left ventricular myocardium-related parameters correlated with FFRCT . Left ventricular mass index of 66.5 g/m 2 was the strongest predictor of a distal FFRCT of >0.80.