Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study. Issue 10 (3rd September 2022)

• Record Type: Journal Article
• Authors: Mortensen, Martin B.; Sand, Niels‐Peter; Busk, Martin; Jensen, Jesper M.; Grove, Erik L.; Dey, Damini; Iraqi, Nadia; Updegrove, Adam; Fonte, Tim; Mathiassen, Ole N.; Hosbond, Susanne; Bøtker, Hans E.; Leipsic, Jonathon; Narula, Jagat; Nørgaard, Bjarne L.
• Is Part Of: Clinical cardiology. Volume 45:Issue 10(2022)
• Page Start: 986
• Page End: 994
• Publication Date: 2022-09-03
• Subjects: angina -- coronary artery disease -- fractional flow reserve -- imaging -- lipid lowering -- statins -- testing; Cardiology -- Periodicals; 616.12005
• DOI: 10.1002/clc.23895
• Languages: English
• ISSNs: 0160-9289

Abstract

Abstract: Introduction: Coronary CT angiography (CTA) derived fractional flow reserve (FFRCT ) shows high diagnostic performance when compared to invasively measured FFR. Presence and extent of low attenuation plaque density have been shown to be associated with abnormal physiology by measured FFR. Moreover, it is well established that statin therapy reduces the rate of plaque progression and results in morphology alterations underlying atherosclerosis. However, the interplay between lipid lowering treatment, plaque regression, and the coronary physiology has not previously been investigated. Aim: To test whether lipid lowering therapy is associated with significant improvement in FFRCT, and whether there is a dose–response relationship between lipid lowering intensity, plaque regression, and coronary flow recovery. Methods: Investigator driven, prospective, multicenter, randomized study of patients with stable angina, coronary stenosis ≥50% determined by clinically indicated first‐line CTA, and FFRCT ≤ 0.80 in whom coronary revascularization was deferred. Patients are randomized to standard (atorvastatin 40 mg daily) or intensive (rosuvastatin 40 mg + ezetimibe 10 mg daily) lipid lowering therapy for 18 months. Coronary CTA scans with blinded coronary plaque and FFRCT analyses will be repeated after 9 and 18 months. The primary endpoint is the 18‐month difference in FFRCT using (1) the FFRCT value 2 cm distal to stenosis and (2) the lowest distal value in the vessel of interest. A total of 104 patients will be included in the study. Conclusion: The results of this study will provide novel insights into the interplay between lipid lowering, and the pathophysiology in coronary artery disease.