Noninvasive Quantitative Plaque Analysis Identifies Hemodynamically Significant Coronary Arteries Disease

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology
• Radiology

Background:

• Coronary artery disease diagnosis relies on assessing lesion-specific hemodynamic abnormalities.
• Fractional flow reserve (FFR) is the gold standard for evaluating hemodynamic significance.
• Non-invasive methods like CCTA are increasingly used for coronary artery assessment.

Purpose of the Study:

• To evaluate the diagnostic performance of automated quantitative analysis by coronary computed tomography angiography (CCTA) in identifying lesion-specific hemodynamic abnormality.
• To compare the accuracy of various CCTA-derived indices in predicting hemodynamic significance.

Main Methods:

• 132 patients with 169 vessels (30%-90% stenosis) underwent CCTA and invasive FFR.
• Automated CCTA software quantified plaque characteristics: maximum diameter stenosis (MDS%), maximum area stenosis (MAS%), lipid plaque volume (LPV), and lipid plaque burden (LPB).
• Logistic regression and ROC analysis determined diagnostic performance for hemodynamic abnormalities (FFR ≤0.80).

Main Results:

• Hemodynamically significant lesions (FFR ≤0.80) were present in 33.73% of vessels.
• MAS% and LPV were significantly higher in vessels with hemodynamic significance.
• Multivariable analysis identified MAS% >68% and LPB >10.03% as significant predictors.
• The area under the curve (AUC) for predicting hemodynamic abnormalities was 0.77 for MAS% and 0.71 for MDS%.
• Combining MAS% and LPB (MAS%+LPB) yielded a significantly higher AUC (0.83) compared to MAS% alone (0.77).

Conclusions:

• Automated CCTA quantitative analysis, particularly MAS%, demonstrates high diagnostic accuracy for coronary hemodynamic abnormalities.
• Lipid plaque burden (LPB) also contributes to identifying significant lesions.
• The combined index of MAS%+LPB offers improved diagnostic accuracy over MAS% alone for predicting lesion-specific hemodynamic abnormalities.