Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in
Seokhun Yang1, Gilwoo Choi2, Jinlong Zhang3
1Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea.
Insights
Local hemodynamic parameters, including wall shear stress and pressure gradient, independently predict acute coronary syndrome (ACS) risk. These factors enhance predictions beyond traditional high-risk plaque indicators and fractional flow reserve (FFRCT).
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Interventional Cardiology
Background:
- The association between local hemodynamic parameters and acute coronary syndrome (ACS) development requires further investigation.
- Understanding these hemodynamic factors is crucial for predicting ACS events.
Purpose of the Study:
- To investigate the association among local hemodynamic parameters and their ability to discriminate culprit lesions from non-culprit lesions.
- To evaluate the predictive value of these hemodynamic parameters for ACS risk.
Main Methods:
- Coronary CT angiography (CCTA) was used to analyze 216 lesions in ACS patients.
- Computational fluid dynamics analysis derived fractional flow reserve (FFRCT) and local hemodynamic parameters (WSS, APS, PG, ΔFFRCT).
- Culprit and non-culprit lesions were identified and compared based on hemodynamic and plaque characteristics.
Main Results:
- Wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG), and delta FFRCT (ΔFFRCT) were strongly correlated.
- These hemodynamic parameters were independent predictors of culprit lesions, improving risk prediction beyond high-risk plaque and FFRCT.
- The combination of FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT showed comparable or superior discrimination to models including WSS, APS, or PG.
Conclusions:
- Local hemodynamic indices are significantly intercorrelated and provide additive, independent predictive value for ACS risk.
- These parameters enhance risk stratification beyond traditional markers like high-risk plaque and reduced FFRCT.
- Hemodynamic assessment offers valuable insights into ACS pathogenesis and patient risk stratification.
Abstract:
Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated. Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1-24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFRCT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFRCT across the lesion (ΔFFRCT) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared. Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFRCT were strongly correlated with each other (all p < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFRCT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFRCT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFRCT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFRCT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT had a similar or superior discrimination ability to that with FFRCT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFRCT did not improve the model performance. Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFRCT.
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