Abstract 20015: Value of Quantitative Atherosclerotic Plaque Assessment Using CCTA to Predict Lesion-specific Ischemia, Data from 407 Coronary Lesions

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ran Heo ◽  
Hyung-Bok Park ◽  
Nakazato Ryo ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
...  
Keyword(s):  
Invasive Coronary Angiography ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Fractional Flow ◽  
Luminal Diameter ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
Significant Difference ◽  
Coronary Lesions ◽  
Tomographic Angiography

Introduction: While coronary computed tomographic angiography (CCTA) demonstrates high diagnostic performance for identification and exclusion of high-grade anatomic stenosis, it is unable to effectively discriminate coronary lesions that causes ischemia. Hypothesis: To study whether quantitative assessment of CCTA offer incremental information for discrimination of lesion ischemia beyond stenosis measures. Methods: 252 consecutive patients with suspected or known coronary artery disease (CAD) from 17 centers in 5 countries were enrolled (mean age 63±9 years, 71% male). Patients underwent CCTA and invasive coronary angiography (ICA), with 407 coronary lesions interrogated by invasive fractional flow reserve (FFR) at the time of maximum hyperemia. For these coronary lesions, we evaluated % diameter stenosis (%DS), % area stenosis (%AS), minimal luminal diameter (MLD, mm), minimal luminal area (MLA, mm 2 ), and plaque burden at MLA by CCTA. Plaque burden (PB, %) was defined as (vessel area–lumen area)/vessel areaх100. Lesion-specific ischemia by FFR was defined as a value ≤0.8. Results: In quantitative analysis area under the receiver operating characteristic curves (AUC) value of %DS, %AS, MLD, MLA, and PB for prediction of ischemia were 0.72 (95% confidence interval (CI) 0.68-0.77, p<0.001), 0.73 (95% CI 0.68-0.77, p<0.001), 0.75 (95% CI 0.70-0.79, p<0.001), 0.75 (95% CI 0.70-0.79, p<0.001), and 0.77 (95% CI 0.73-0.81, p<0.001), respectively. PB showed significantly improved AUC when compared to % area stenosis (p=0.002). However, PB didn’t show incremental power over MLA (p=0.213). There also was no significant difference in AUC between MLA and % area stenosis (p=0.330) Conclusions: Quantitative plaque assessment using CCTA could predict lesion-specific ischemia with good discrimination. Plaque burden showed incremental value over % area stenosis for ischemia prediction.

Additional value of deep learning computed tomographic angiography-based fractional flow reserve in detecting coronary stenosis and predicting outcomes

2021 ◽  
pp. 028418512098397
Author(s):  
Yang Li ◽  
Hong Qiu ◽  
Zhihui Hou ◽  
Jianfeng Zheng ◽  
Jianan Li ◽  
...  
Keyword(s):  
Deep Learning ◽  
Unstable Angina ◽  
Fractional Flow Reserve ◽  
Predictive Value ◽  
Computed Tomographic Angiography ◽  
Fractional Flow ◽  
Computed Tomographic ◽  
Flow Reserve ◽  
Sensitivity Specificity ◽  
Tomographic Angiography

Background Deep learning (DL) has achieved great success in medical imaging and could be utilized for the non-invasive calculation of fractional flow reserve (FFR) from coronary computed tomographic angiography (CCTA) (CT-FFR). Purpose To examine the ability of a DL-based CT-FFR in detecting hemodynamic changes of stenosis. Material and Methods This study included 73 patients (85 vessels) who were suspected of coronary artery disease (CAD) and received CCTA followed by invasive FFR measurements within 90 days. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristics curve (AUC) were compared between CT-FFR and CCTA. Thirty-nine patients who received drug therapy instead of revascularization were followed for up to 31 months. Major adverse cardiac events (MACE), unstable angina, and rehospitalization were evaluated and compared between the study groups. Results At the patient level, CT-FFR achieved 90.4%, 93.6%, 88.1%, 85.3%, and 94.9% in accuracy, sensitivity, specificity, PPV, and NPV, respectively. At the vessel level, CT-FFR achieved 91.8%, 93.9%, 90.4%, 86.1%, and 95.9%, respectively. CT-FFR exceeded CCTA in these measurements at both levels. The vessel-level AUC for CT-FFR also outperformed that for CCTA (0.957 vs. 0.599, P < 0.0001). Patients with CT-FFR ≤0.8 had higher rates of rehospitalization (hazard ratio [HR] 4.51, 95% confidence interval [CI] 1.08–18.9) and MACE (HR 7.26, 95% CI 0.88–59.8), as well as a lower rate of unstable angina (HR 0.46, 95% CI 0.07–2.91). Conclusion CT-FFR is superior to conventional CCTA in differentiating functional myocardial ischemia. In addition, it has the potential to differentiate prognoses of patients with CAD.

Abstract 18309: Integration of Quantitative Measures of Stenosis Severity With Morphologic Atherosclerotic Plaque Characteristics Improves Discrimination of Coronary Lesions that Cause Ischemia: Results from a Prospective Multicenter International Trial

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hyung-Bok Park ◽  
Nakazato Ryo ◽  
Ran Heo ◽  
Iksung Cho ◽  
Heidi Gransar ◽  
...  
Keyword(s):  
Atherosclerotic Plaque ◽  
International Study ◽  
Computed Tomographic Angiography ◽  
Operating Characteristics ◽  
Plaque Volume ◽  
Fractional Flow ◽  
Luminal Diameter ◽  
Flow Reserve ◽  
Stenosis Severity ◽  
Coronary Lesions

Background: Beyond stenosis severity, coronary computed tomographic angiography (CCTA) enables morphologic evaluation of atherosclerotic plaque characteristics (APCs), including aggregate plaque volume, positive arterial remodeling (PR), low attenuation plaque (LAP) and spotty calcification (SC), features associated with global myocardial ischemia and acute coronary syndromes. We determined whether the combination of stenosis severity plus APCs would improve the discrimination of coronary lesions that cause ischemia. Method: 252 patients from 17 centers in 5 countries [mean age 63 years, 71% males] underwent CCTA and invasive angiography, with invasive fractional flow reserve (FFR) performed for 407 coronary lesions. Stenosis severity was determined by luminal diameter reduction (%DS). Aggregate plaque volume (APV) was defined as the plaque volume from ostium to distal end of the lesion, with APV percent (%APV) defined as APV divided by total vessel volume. Other APCs by CCTA were defined as: (1) PR, lesion diameter/reference diameter >1.10; (2) LAP, any voxel <30 HU; and (3) SC, nodular calcified plaque <3 mm. Lesion ischemia was defined by invasive FFR ≤0.8, which was employed as the reference standard. Results: Coronary stenosis severity and APCs demonstrated good discrimination for lesion ischemia: %DS, (Area under the receiver operating characteristics curve [AUC] of 0.72 (95% CI 0.68-0.77), APV (AUC 0.69, 95% CI 0.64-0.73), and %APV (0.75, 98% CI 0.70-0.79). Over %DS alone, the addition of %APV improved the discrimination of lesion-specific ischemia (0.79, 95% CI 0.75-0.83, p<0.001), with further improvement with increasing APC number (0.86, 95% CI 0.82-0.89, p<0.001) [Figure]. Conclusion: In this prospective multicenter international study, the combination of quantitative measures of stenosis severity with morphologic features of atherosclerotic plaque by CCTA resulted in improved discrimination of coronary lesion-specific ischemia.

scholarly journals A New Approach in Risk Stratification by Coronary CT Angiography

Scientifica ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-10
Author(s):  
Rine Nakanishi ◽  
Matthew J. Budoff
Keyword(s):  
Risk Stratification ◽  
Invasive Coronary Angiography ◽  
Coronary Plaque ◽  
Computed Tomographic Angiography ◽  
Plaque Burden ◽  
Cardiovascular Risks ◽  
Computed Tomographic ◽  
Coronary Ct ◽  
Hemodynamic Information ◽  
Tomographic Angiography

For a decade, coronary computed tomographic angiography (CCTA) has been used as a promising noninvasive modality for the assessment of coronary artery disease (CAD) as well as cardiovascular risks. CCTA can provide more information incorporating the presence, extent, and severity of CAD; coronary plaque burden; and characteristics that highly correlate with those on invasive coronary angiography. Moreover, recent techniques of CCTA allow assessing hemodynamic significance of CAD. CCTA may be potentially used as a substitute for other invasive or noninvasive modalities. This review summarizes risk stratification by anatomical and hemodynamic information of CAD, coronary plaque characteristics, and burden observed on CCTA.

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