P6319CT derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R P J Budde ◽  
F M A Nous ◽  
A A Constantinescu ◽  
K Nieman ◽  
L M Koweek ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Vessel Disease ◽  
Transplant Patients ◽  
Flow Reserve

Abstract Background Cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality after heart transplantation. Annual screening is recommended to improve risk stratification and early treatment of CAV and is often performed with invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) with CCTA-derived fractional flow reserve (FFRct) might be a non-invasive alternative to ICA for the surveillance of CAV providing both anatomical and functional information. Purpose To describe our initial results with CCTA and FFRct for detection of CAV in a cohort of heart transplant patients. Methods Heart transplant patients who underwent CCTA with FFRct as part of routine annual assessment for CAV were enrolled in a prospective registry from February 2018 to February 2019 in a single center. The most recently known CAV score (0–3) based on invasive angio and single photon emission computed tomography (SPECT) before CCTA was recorded. CCTA image quality was scored as non-diagnostic, moderate, good or excellent. FFRct analysis was performed off-site by a commercial company. For each coronary stenosis >30%, an FFRCTvalue distal to the stenosis was measured. For the RCA, LAD and CX without a stenosis, the FFRct value in the most distal location in the vessel was recorded. CAV classification was rescored based on CCTA. Demographics, additional diagnostic tests, and treatment plans were evaluated including major adverse events (MACE) during 90-day follow-up. Results 65 patients (56 (39–65) years (median/ 25th–75thpercentile), 40% women) that were 11 (7–16) years after transplantation were included. The most recent CAV score was 0 in 52 patients (80%) and 1 or 2 in 13 patients. CCTA image quality was good or excellent in 59 (91%) patients. CCTA reclassified CAV scores in 32 (49%) patients to 33 patients with CAV 0, 18 patients with CAV 1, 9 patients with CAV 2 and 5 patients with CAV 3. In 17 patients (26%) at least one stenosis with FFRct ≤0.80 was detected including 11 patients with single vessel disease, 5 with two-vessel disease and one with three-vessel disease. In the 48 patients without a focal stenosis, mean distal FFRct values were 0.88 (0.86–0.91), 0.87 (0.85–0.90) and 0.90 (0.86–0.91) at less than 10, 10–15 or more than 15 years after transplantation, respectively (p=0.457). Additional tests were performed in 10 (15%) patients (1 SPECT and 10 invasive coronary angiographies), which resulted in revascularization by PCI in 6 (9%) patients. No MACE occurred during 90-day follow-up. Conclusion CCTA with FFRct can be successfully performed in heart transplant patients, detects patients with significant coronary stenosis and CCTA leads to substantial reclassification of CAV grades. Acknowledgement/Funding FFRct analysis was performed as part of the ADVANCE registry which is supported by Heartflow Inc.

scholarly journals CT-derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation

2021 ◽  
Author(s):  
Ricardo P. J. Budde ◽  
Fay M. A. Nous ◽  
Stefan Roest ◽  
Alina A. Constantinescu ◽  
Koen Nieman ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Heart Transplantation ◽  
Fractional Flow Reserve ◽  
Heart Transplant ◽  
Coronary Stenosis ◽  
Fractional Flow ◽  
Significant Stenosis ◽  
Transplant Patients ◽  
Flow Reserve ◽  
Focal Stenosis

Abstract Objectives Invasively measured fractional flow reserve (FFR) is associated with outcome in heart transplant (HTx) patients. Coronary computed tomography angiography (CCTA)–derived FFR (FFRct) provides additional functional information from anatomical CT images. We describe the first use of FFRct in HTx patients. Methods HTx patients underwent CCTA with FFRct to screen for cardiac allograft vasculopathy. FFRct was measured distal to each coronary stenosis > 30% and FFRct ≤ 0.8 indicated hemodynamically significant stenosis. FFRct was also measured at the most distal location of each vessel. Overall distal FFRct was calculated as the mean of the distal values in the left, right, and circumflex coronary artery in each patient. Results Seventy-three patients (age 56 (42–65) years, 63% males) at 11 (8–16) years after HTx were included. Eighteen (25%) patients had a focal hemodynamically significant stenosis (stenosis > 30% with FFRct ≤ 0.8). In the 55 patients without a hemodynamically significant focal FFRct stenosis (FFRct > 0.80), the distal left anterior descending artery FFRct was < 0.90 in 74% of the patients and 10 (18%) patients had ≥ 1 coronary artery with a distal FFRct ≤ 0.8, including 1 with a distal FFRct ≤ 0.8 in all coronaries. Overall distal FFRct in patients without focal stenosis was 0.88 (0.86–0.91), 0.87 (0.86–0.90), and 0.88 (0.86–0.91) (median with 25th–75th percentile) at 5–9, 10–14, or ≥ 15 years post-transplantation, respectively (p = 0.93). Conclusions FFRct performed on CCTA scans of HTx patients demonstrated that 25% of patients had a focal coronary stenosis with FFRct ≤ 0.8. Even without a focal stenosis, FFRct values are often abnormal in HTx patients. Key Points • This is the first report describing the use of FFRct in in heart transplant patients. • FFRct identifies patients after heart transplantation with hemodynamically significant coronary stenosis. • Even without a focal stenosis, FFRct values are often abnormal in heart transplant patients.

scholarly journals Physiological Evaluation of Anomalous Aortic Origin of a Coronary Artery Using Computed Tomography–Derived Fractional Flow Reserve

2021 ◽  
Author(s):  
Julien Adjedj ◽  
Fabien Hyafil ◽  
Xavier Halna du Fretay ◽  
Patrick Dupouy ◽  
Jean‐Michel Juliard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Ct Angiography ◽  
Fractional Flow Reserve ◽  
Coronary Ct Angiography ◽  
Functional Evaluation ◽  
Fractional Flow ◽  
Coronary Ct ◽  
Flow Reserve

Background With the emergence of coronary computed tomography (CT) angiography, anomalous aortic origin of a coronary artery (ANOCOR) is more frequently diagnosed. Fractional flow reserve derived from CT (FFRCT) is a noninvasive functional test providing anatomical and functional evaluation of the overall coronary tree. These unique features of anatomical and functional evaluation derived from CT could help for the management of patients with ANOCOR. We aimed to retrospectively evaluate the physiological and clinical impact of FFRCT analysis in the ANOCOR registry population. Methods and Results The ANOCOR registry included patients with ANOCOR detected during invasive coronary angiography or coronary CT angiography between January 2010 and January 2013, with a planned 5‐year follow‐up. We retrospectively performed FFRCT analysis in patients with coronary CT angiography of adequate quality. Follow‐up was performed with a clinical composite end point (cardiac death, myocardial infarction, and unplanned revascularization). We obtained successful FFRCT analyses and 5‐year clinical follow‐up in 54 patients (average age, 60±13 years). Thirty‐eight (70%) patients had conservative treatment, and 16 (30%) patients had coronary revascularization after coronary CT angiography. The presence of an ANOCOR course was associated with a moderate reduction of FFRCT value from 1.0 at the ostium to 0.90±0.10 downstream the ectopic course and 0.82±0.11 distally. No significant difference in FFRCT values was identified between at‐risk and not at‐risk ANOCOR. After a 5‐year follow‐up, only one unplanned percutaneous revascularization was reported. Conclusions The presence of ANOCOR was associated with a moderate hemodynamic decrease of FFRCT values and associated with a low risk of cardiovascular events after a 5‐year follow‐up in this middle‐aged population.

P3575Clinical importance of fractional flow reserve in patients with organic coronary stenosis and vasospastic angina

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Hao ◽  
J Takahashi ◽  
A Suda ◽  
K Sato ◽  
J Sugisawa ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Fractional Flow Reserve ◽  
Coronary Stenosis ◽  
Coronary Spasm ◽  
Provocation Test ◽  
Vasospastic Angina ◽  
Prognostic Impact ◽  
Fractional Flow ◽  
Flow Reserve

Abstract Background Vasospastic angina (VSA), which is one of the important functional cardiac disorders, may also play a role in the pathogenesis of atherosclerosis. Conversely, organic coronary stenosis is also known as an independent predictor for poor clinical outcomes in VSA patients. Although VSA patients have a variable degree of organic coronary stenosis in clinical setting, the functional importance of organic stenosis in those patients remains to be elucidated. Purpose The aim of this study was to examine the clinical importance and prognostic impact of fractional flow reserve (FFR) in patients with VSA and organic coronary stenosis. Methods We enrolled 236 consecutive patients with suspected vasospastic angina who underwent acetylcholine provocation test for coronary spasm (M/F 148/88, 63.6±12.0 [SD] yrs.). Among them, 175 patients (74.1%) were diagnosed as having VSA, while the remaining non-VSA patients were regarded as controls (Group-C, n=61). We divided the VSA patients into 3 groups based on angiographical findings and FFR values; VSA with no organic stenosis (>50% luminal stenosis) (Group-N, n=110), organic stenosis and high FFR (≥0.80) (Group-H, FFR 0.87±0.05, n=36), and organic stenosis and low FFR (<0.80) (Group-L, FFR 0.71±0.07, n=29). We evaluated the incidence of major adverse cardiovascular events (MACE), including cardiovascular death (CVD), non-fatal myocardial infarction (MI), urgent percutaneous coronary intervention (PCI), and hospitalization due to unstable angina pectoris (UAP) during the median follow-up period of 656 days. Results The groups with organic stenosis (Groups H and L) were characterized by higher prevalence of diabetes mellitus (Group-C/N/H/L, 23.0/20.9/44.4/34.5%, P=0.03) and dyslipidemia (Group-C/N/H/L, 37.7/39.1/50.0/65.5%, P=0.03) as compared with Group-C. After provocation test, all VSA patients received calcium channel blockers (CCBs). In addition, 20 days (median) after provocation test, 26 patients (92.9%) in Group-L underwent elective PCI with coronary stents, while no patient underwent PCI in Groups N or H. The incidence of MACE during follow-up was significantly higher in Group-L (Group-C/N/H/L; 1.6/3.6/5.6/27.6%, log-rank P<0.001), whereas clinical outcomes were comparable among the remaining 3 groups (Figure). Importantly, all 8 patients with MACE in Group-L had poor outcomes (CVD/MI/urgent PCI/UAP; 2/1/3/2) despite complete revascularization and the prevention of coronary spasm with CCBs, indicating that they might be resistant to standard contemporary therapies. They were characterized by less frequent use of angiotensin convert enzyme inhibitor (0 vs. 47.6%, P=0.02) and higher prevalence of multi-vessel organic lesions (37.5 vs. 4.8%, P=0.052) compared with those without MACE. Figure 1 Conclusions These results provide the first evidence that evaluation of coronary functional abnormalities with FFR is useful for making therapeutic strategies in VSA patients with organic coronary stenosis.

scholarly journals Predictors of CT-derived FFR in patients with suspected CAD beyond severity of coronary stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Smolka ◽  
A Fava ◽  
M Moshage ◽  
M Marwan ◽  
S Achenbach ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Regression Analysis ◽  
Image Quality ◽  
Coronary Stenosis ◽  
Cleveland Clinic ◽  
Suspected Coronary Artery Disease ◽  
Fractional Flow ◽  
Clinical Criteria ◽  
Flow Reserve

Abstract Background Functional assessment of coronary stenosis using computational fluid dynamics is increasingly used, however other factors besides coronary stenosis may affect the results. We assessed several predictors for CT-derived fractional flow reserve (CT-FFR) in patients with suspected coronary artery disease (CAD) undergoing coronary computed tomographic angiography (CCTA). Methods 2505 consecutive patients with suspected CAD undergoing CCTA from 2008 to 2016 were screened, 1549 were excluded due to incomplete data (934), image quality (345), software error (147) or other reasons (123). Minimal CT-FFR was measured using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany) in coronaries ≥2mm. Several clinical as well as technical criteria were assessed for predicting the minimal CT-FFR per patient. Results 956 patients (51±12 years, 51.2% men) were included in this analysis. Mean EF was 59.4±7.4%, heart rate 63±9 bpm, systolic (126.5±20mmHg) and diastolic (70±11 mmHg) blood pressure (BP). Regression analysis and ANOVA showed low but significant impact on minimal CT-FFR (mean 0.85±0.10) by EF, aortic valvular dysfunction, heart rate and systolic blood pressure as well as image quality (esp. blooming and image noise). See Tables 1 and 2. Conclusion Coronary stenosis may not be the only relevant predictor for CT-FFR. Several clinical criteria (EF, heart rate, BP, aortic valve dysfunction) as well as image criteria (image quality, artifacts) can affect CT-FFR results. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Cleveland Clinic Foundation Table 1. ANOVA analysis Table 2. Regression analysis

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