Plaque Volume and Morphology are Associated with Fractional Flow Reserve Derived from Coronary Computed Tomography...

Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR_CT) accurately diagnoses ischemic lesions of intermediate stenosis severity. However, significant determinants of FFR_CT have not been fully evaluated.

This was a sub-analysis of the Treatment of Alogliptin on Coronary Atherosclerosis Evaluated by Computed Tomography-Based Fractional Flow Reserve trial. Thirty-nine diabetic patients (117 vessels) with intermediate coronary artery stenosis [percent diameter stenosis (%DS) ＜70%] in whom FFR_CT was measured were included in this study. CCTA-defined, vessel-based volumetric and morphological characteristics of plaques were examined to determine their ability to predict FFR_CT.

Patient-based, multivariate linear regression analysis showed that hemoglobinA1c, triglycerides, and the estimated glomerular filtration rate were significant independent factors associated with FFR_CT. Vessel-based, univariate linear regression analysis showed that the total atheroma volume (r=－0.233, p=0.01) and the percentage atheroma volume (PAV) (r=－0.284, p=0.002) as well as %DS (r=－0.316, p=0.006) were significant determinants of FFR_CT. Among the plaque components, significant negative correlations were observed between FFR_CT and low- (r=－0.248, p=0.007) or intermediate-attenuation plaque volume (r=－0.186, p=0.045), whereas calcified plaque volume was not associated with FFR_CT. In the left anterior descending coronary artery (LAD), the plaque volume of each component was associated with FFR_CT.

Plaque volume, PAV, and %DS were significant determinants of FFR_CT. Plaque morphology, particularly in LAD, was associated with FFR_CT in diabetic patients with intermediate coronary artery stenosis.