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What is the optimal anatomic location for coronary artery pressure measurement at CT-derived FFR?
Mateusz Solecki1, Mariusz Kruk1, Marcin Demkow1
1Coronary Artery Disease and Structural Heart Disease Department, Institute of Cardiology, Alpejska 42 St, 04-628 Warsaw, Poland.
Insights
Determining the optimal location for computed tomography-fractional flow reserve (CT-FFR) measurements is crucial for accurately assessing coronary artery stenosis. This study found that measuring CT-FFR at 41 mm or 10.9 times the reference diameter distal to the minimum lumen area best predicts lesion-specific ischemia.
Area of Science:
- Cardiac imaging
- Cardiovascular diagnostics
- Non-invasive cardiology
Background:
- Computed tomography-fractional flow reserve (CT-FFR) is gaining traction in cardiac imaging.
- The ideal anatomical location for CT-FFR computation distal to a stenosis remains undefined.
- This study aimed to identify the optimal site for CT-FFR measurements to predict lesion-specific ischemia.
Purpose of the Study:
- To determine the most appropriate anatomical location distal to a coronary artery stenosis for CT-FFR measurements.
- To establish the optimal CT-FFR measurement site for predicting lesion-specific ischemia using stress cardiac magnetic resonance (CMR) as a reference standard.
Main Methods:
- 73 patients with intermediate coronary stenosis underwent CT coronary angiography (CTA) and stress CMR.
- CT-FFR values were computed at various locations distal to the minimum lumen area (MLA).
- Locations were defined by distance (mm) and as a multiple of the reference vessel diameter distal to the MLA.
Main Results:
- CT-FFR measurements at 41 mm or 10.9 times the proximal reference diameter distal to the MLA demonstrated the highest diagnostic accuracy (AUC 0.866).
- These locations showed superior agreement with inducible ischemia detected by CMR compared to other measurement sites or CTA stenosis severity alone.
- Optimal thresholds for CT-FFR agreement with CMR were identified at 41 mm or 10.9 times the proximal reference diameter.
Conclusions:
- The optimal location for CT-FFR computation to predict lesion-specific ischemia is 41 mm or 10.9 times the proximal reference diameter distal to the MLA.
- These findings enhance the accuracy and reliability of non-invasive CT-FFR assessment in coronary artery disease.
- Accurate CT-FFR site selection improves the diagnostic performance of CT angiography for evaluating coronary stenosis.
Background:
CT-FFR is an area of growing interest in the field of cardiac imaging. However, the specific anatomic location distal to a lesion of interest where CT-FFR should be computed to yield the most valid results has not been examined. This study investigated the most appropriate anatomic location distal to a coronary artery stenosis for obtaining CT-FFR measurements.
Methods:
73 patients (60 ± 9 years; 58% male) with at least one coronary lesion with 40-90% stenosis on coronary CTA (either a 2 × 128 slice or a 2 × 192 slice dual-source CT scanner) underwent stress cardiac magnetic resonance (CMR) perfusion imaging for inducible ischemia. 133 coronary arteries and corresponding myocardial territories were analyzed. The most appropriate anatomic location for predicting lesion-specific ischemia via CT-FFR (cFFR version 1.4, Siemens) was determined as either the distance from the lesion of interest or as a multiple of the reference vessel diameter distal to the minimum lumen area (MLA).
Results:
Inducible myocardial ischemia was found on MRI in 24 (18.1%) vessels/corresponding myocardial territories. The area under the ROC curve was A) 0.866 for CT-FFR measurement locations distal to the MLA expressed as a multiple of the reference diameter, B) 0.854 when expressed as a distance (mm) distal to the MLA, C) 0.803 for CT-FFR values measured in the distal vessel, and D) 0.725 according to stenosis severity on coronary CTA (A vs B p = 0.093; A vs D p = 0.003; A vs C p = 0.019; B vs D p = 0.006; B vs C p = 0.061; C vs D p = 0.082). The most optimal thresholds for agreement of CT-FFR with the reference CMR perfusion were at 41 mm or 10.9 times the proximal reference diameter distal to the MLA.
Conclusions:
Our results suggest that the best agreement of CT-FFR with the reference CMR perfusion study is provided when CT-FFR values are computed at 41 mm or 10.9 times the proximal reference diameter distal to the MLA.
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