CT-FFR vs a model of combined plaque characteristics for identifying ischemia: Results from CT-FFR CHINA trial. Issue 138 (May 2021)

• Record Type: Journal Article
• Authors: Zhao, Na; Gao, Yang; Xu, Bo; Jiang, Tao; Xu, Li; Hu, Hongjie; Li, Lin; Chen, Wenqiang; Li, Dumin; Zhang, Feng; Fan, Lijuan; Lu, Bin
• Is Part Of: European journal of radiology. Issue 138(2021)
• Publication Date: 2021-05
• Subjects: FFR fractional flow reserve -- INV-FFR Invasive FFR -- CCTA coronary computed tomography angiography -- CT-FFR fractional flow reserve derived from coronary computed tomography angiography -- CAD coronary artery disease -- ICA invasive coronary angiography -- BMI body mass index -- CACs coronary artery calcium score -- PB plaque burden -- VR < 30HU volume ratio of plaque subcomponents at < 30 Hounsfield Units -- LL lesion length -- DS diameter stenosis -- HRP high-risk plaques -- AUC area under receiver operating characteristics curve -- LAD left anterior descending coronary artery -- RCA right coronary artery -- LCX left circumflex artery; Coronary artery disease -- Computed tomography angiography -- Fractional flow reserve -- Myocardial -- CT-FFR -- Plaque characteristics; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109634
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: CT-FFR is powerful for functional evaluation of obstructive and nonobstructive CAD. Almost 20 % patients with nonobstructive CAD have actual myocardial ischemia. For nonobstructive CAD, plaque feature analysis is a great alternative to CT-FFR. Abstract: Objectives: To evaluate the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA; CT-FFR) and combined plaque characteristics for ischemia in different CCTA stenosis levels. Methods: This clinical trial analyzed 317 patients with 30 %–90 % coronary stenosis in 366 vessels from 5 centers undergoing CCTA and invasive FFR. 366 vessels were assigned into &lt; 50 % (nonobstructive) and ≥ 50 % (obstructive) stenosis groups. Lesion length (LL), plaque burden (PB), diameter stenosis (DS), volume ratio of plaque subcomponents &lt; 30 HU (VR &lt; 30HU), and high-risk features were analyzed. Logistic regression models were used to identify plaque characteristic predictors for lesion-specific ischemia in different stenosis grades. The area under receiver operating characteristics curve (AUC) of integrated plaque characteristics and CT-FFR were calculated and compared. Results: In &lt; 50 % stenosis lesions, PB (OR: 1.296, p = 0.002), LL (OR:1.075, p = 0.020), and DS (OR:1.085, p = 0.031) were independent predictors of ischemia. In ≥ 50 % stenosis lesions, VR &lt; 30HU (OR:1.031, p = 0.005) and DS (OR: 1.020, p = 0.044) were independent predictors for ischemia. AUC of plaque characteristic (VR &lt; 30HU plus DS) for ischemia was 0.67 (95 % CI: 0.61–0.72) in ≥ 50 % stenosis level, which was significantly lower than CT-FFR (AUC=0.90; 95 % CI: 0.86–0.93) ( p &lt; 0.001). For lesions causing &lt; 50 % stenosis, AUC of combined plaque model (VR &lt; 30HU plus DS) was 0.88 (95 % CI: 0.80–0.95), equivalent to AUC of CT-FFR (AUC = 0.88; 95 % CI: 0.80–0.96; p = 0.957). Conclusion: CT-FFR is a powerful functional assessment tool for both obstructive and nonobstructive diseases. However, for nonobstructive CAD confirmed by CCTA, a model of a combination of plaque characteristics could be a valuable alternative to CT-FFR.