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Evaluation of Coronary Flow Reserve After Myocardial Ischemia Reperfusion in Rats
Published on: June 28, 2019
Correlation between coronary computed tomographic angiography and fractional flow reserve
Thomas Skaarup Kristensen1, Thomas Engstrøm, Henning Kelbæk
1Department of Radiology, Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark. tskaarup@yahoo.com
Insights
Coronary CT angiography (CCTA) correlates with fractional flow reserve (FFR) for assessing coronary artery disease severity. Quantitative CCTA criteria can effectively rule out significant coronary stenoses, aiding clinical decision-making.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Radiology
Background:
- Coronary CT angiography (CCTA) is vital for evaluating coronary artery disease.
- Intermediate coronary artery stenosis presents a therapeutic challenge.
- Fractional flow reserve (FFR) is the gold standard for assessing lesion hemodynamic significance.
Purpose of the Study:
- To compare the diagnostic accuracy of CCTA with FFR in evaluating coronary artery stenoses.
- To determine quantitative CCTA parameters that correlate with FFR values.
Main Methods:
- 56 coronary artery stenoses in 42 patients were assessed using CCTA and FFR.
- CCTA quantitative analysis included diameter stenosis, area stenosis, minimal lumen diameter, minimal lumen area, lesion length, plaque volume, and plaque burden.
- Correlation and regression analyses were performed to compare CCTA metrics with FFR.
Main Results:
- FFR averaged 0.81±0.14, with 10 lesions showing abnormal FFR (<0.75).
- Significant correlations were found between FFR and CCTA metrics: area stenosis (r=-0.68), lesion length (r=-0.36), and plaque burden (r=-0.59).
- Area stenosis >73% and lesion length >10 mm were strong determinants of abnormal FFR, with high negative predictive values.
Conclusions:
- Quantitative CCTA measurements are significantly correlated with FFR.
- Established CCTA criteria can reliably exclude hemodynamically significant coronary artery stenoses.
- CCTA offers a non-invasive method to assess coronary lesion severity, potentially guiding therapeutic decisions.
Background:
Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established technique to determine the hemodynamic severity of a coronary artery lesion. The aim of this study was to compare CCTA with FFR.
Methods:
In 56 coronary artery stenoses (42 patients) we performed CCTA, quantitative coronary angiography and FFR. CCTA measurements included diameter stenosis (DS, %), area stenosis (AS, %), minimal lumen diameter (MLD, mm), minimal lumen area (MLA, mm(2)), lesion length (LL, mm), plaque volume (mm(3)) and burden (%).
Results:
FFR averaged 0.81±0.14, and 10 lesions had an abnormal FFR (<0.75). We found significant correlations between FFR and DS (r=-0.67, p<0.001), AS (r=-0.68, p<0.001), MLD (r=0.58, p<0.001), MLA (r=0.53, p<0.001), LL (r=-0.36, p=0.02), plaque volume (r=-0.36, p=0.02) and plaque burden (r=-0.59, p<0.001). By multivariate regression analysis AS and LL were the strongest determinants of an abnormal FFR. The optimal cut-off value for AS was >73% (sensitivity 90%, specificity 80%, negative predictive value 97%, and positive predictive value 50%) and for LL >10 mm (sensitivity 60% and specificity 49%).
Conclusion:
This study demonstrates that quantitative CCTA is correlated to FFR. Using our CCTA criteria of abnormality, significant coronary artery stenoses can be ruled out with a high negative predictive value.
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