Improved diagnostic performance of transluminal attenuation gradient in combination with morphological evaluation of coronary artery stenosis using 320-row computed tomography

2017 ◽  
Vol 36 (1) ◽  
pp. 51-58 ◽  
Author(s):  
Kyohei Nagata ◽  
Ryoichi Tanaka ◽  
Hidenobu Takagi ◽  
Tetuya Fusazaki ◽  
Yoshihiro Morino ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Performance ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Morphological Evaluation ◽  
Transluminal Attenuation Gradient

scholarly journals Application of speCtraL computed tomogrAphy to impRove specIficity of cardiac compuTed tomographY (CLARITY study): rationale and design

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e025793 ◽  
Author(s):  
Robbert Willem van Hamersvelt ◽  
Ivana Išgum ◽  
Pim A de Jong ◽  
Maarten Jan Maria Cramer ◽  
Geert E H Leenders ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Diagnostic Performance ◽  
Coronary Artery Stenosis ◽  
Static Stress ◽  
Artery Stenosis ◽  
Study Endpoint ◽  
Primary Study ◽  
Fractional Flow ◽  
Significant Coronary Artery Stenosis

IntroductionAnatomic stenosis evaluation on coronary CT angiography (CCTA) lacks specificity in indicating the functional significance of a stenosis. Recent developments in CT techniques (including dual-layer spectral detector CT [SDCT] and static stress CT perfusion [CTP]) and image analyses (including fractional flow reserve [FFR] derived from CCTA images [FFRCT] and deep learning analysis [DL]) are potential strategies to increase the specificity of CCTA by combining both anatomical and functional information in one investigation. The aim of the current study is to assess the diagnostic performance of (combinations of) SDCT, CTP, FFRCTand DL for the identification of functionally significant coronary artery stenosis.Methods and analysisSeventy-five patients aged 18 years and older with stable angina and known coronary artery disease and scheduled to undergo clinically indicated invasive FFR will be enrolled. All subjects will undergo the following SDCT scans: coronary calcium scoring, static stress CTP, rest CCTA and if indicated (history of myocardial infarction) a delayed enhancement acquisition. Invasive FFR of ≤0.80, measured within 30 days after the SDCT scans, will be used as reference to indicate a functionally significant stenosis. The primary study endpoint is the diagnostic performance of SDCT (including CTP) for the identification of functionally significant coronary artery stenosis. Secondary study endpoint is the diagnostic performance of SDCT, CTP, FFRCTand DL separately and combined for the identification of functionally significant coronary artery stenosis.Ethics and disseminationEthical approval was obtained. All subjects will provide written informed consent. Study findings will be disseminated through peer-reviewed conference presentations and journal publications.Trial registration numberNCT03139006; Pre-results.

scholarly journals Prevalence of pathological FFRCT values without coronary artery stenosis in an asymptomatic marathon runner cohort

2021 ◽  
Author(s):  
Sebastian Gassenmaier ◽  
Ilias Tsiflikas ◽  
Simon Greulich ◽  
Jens Kuebler ◽  
Florian Hagen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Artery Stenosis ◽  
Artery Stenosis ◽  
Fractional Flow ◽  
Marathon Runners ◽  
Coronary Artery Segment ◽  
Relevance Evaluation ◽  
Artery Segment ◽  
Distal Vessel

Abstract Objectives To evaluate computed tomography fractional flow reserve (FFRCT) values in distal parts of the coronaries in an asymptomatic cohort of marathon runners without any coronary stenosis for potentially false-positive values. Methods Ninety-eight asymptomatic male marathon runners (age 53 ± 7 years) were enrolled in a prospective monocentric study and underwent coronary computed tomography angiography (CCTA). CCTA data were analyzed for visual coronary artery stenosis. FFRCT was evaluated in 59 participants without coronary artery stenosis in proximal, mid, and distal coronary sections using an on-site software prototype. Results In participants without coronary artery stenosis, abnormal FFRCT values ≤ 0.8 in distal segments were found in 22 participants (37%); in 19 participants in the LAD; in 5 participants in the LCX; and in 4 participants in the RCA. Vessel diameters in participants with FFRCT values > 0.80 compared to ≤ 0.80 were 1.6 ± 0.3 mm versus 1.5 ± 0.3 mm for distal LAD (p = 0.025), 1.8 ± 0.3 mm versus 1.6 ± 0.5 mm for distal LCX (p = 0.183), and 2.0 ± 0.4 mm versus 1.5 ± 0.2 mm for distal RCA (p < 0.001). Conclusions Abnormal FFRCT values of ≤ 0.8 frequently occurred in distal coronary segments in subjects without any anatomical coronary artery stenosis. This effect is only to some degree explainable by small distal vessel diameters. Therefore, the validity of hemodynamic relevance evaluation using FFRCT in distal coronary artery segment stenosis is reduced. Key Points • Abnormal FFRCT values (≤ 0.8) occurred in over a third of the subjects in the distal LAD despite the absence of coronary artery stenosis.. • Therefore, the validity of hemodynamic relevance evaluation in distal coronary artery segment stenosis is reduced. • Decision-making based on abnormal FFRCT values in distal vessel sections should be performed with caution and only in combination with visual assessment of the grade of stenosis..

Differential impact of target vessel on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Takashima ◽  
H Ohashi ◽  
H Ando ◽  
A Suzuki ◽  
S Sakurai ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Diagnostic Accuracy ◽  
Functional Significance ◽  
Diagnostic Performance ◽  
Coronary Artery Stenosis ◽  
Stable Condition ◽  
Artery Stenosis ◽  
Lesion Length ◽  
Target Vessel ◽  
Roc Curve Analysis

Abstract Background Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel. Method This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis. Results In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p&lt;0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p&lt;0.001, LCX; r=0.771, p&lt;0.001, RCA; r=0.769, p&lt;0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p&lt;0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p&lt;0.01 for LAD compared to LCX, p&lt;0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p&lt;0.05 for among 3 vessels). Conclusion RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice. Funding Acknowledgement Type of funding source: None

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