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Published on: April 13, 2015
Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive
Toshimitsu Tsugu1, Kaoru Tanaka1, Dries Belsack1
1Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
Insights
High left-ventricular mass can lead to underestimation of coronary artery disease severity using computed tomography-derived fractional flow reserve (FFRCT). Clinicians should consider left-ventricular myocardium parameters when interpreting FFRCT values in significant obstructive coronary artery disease.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Diagnostics
Background:
- Significant obstructive coronary artery disease (SOCAD) can present assessment discrepancies between invasive coronary angiography (ICA) and computed tomography (CT)-derived fractional flow reserve (FFRCT).
- A mismatch in FFRCT can lead to underestimation of coronary artery stenosis severity.
Purpose of the Study:
- To identify factors causing an FFRCT > 0.80.
- To determine predictors of underestimation of coronary artery stenosis severity in SOCAD vessels.
Main Methods:
- Evaluated 141 patients with >75% stenosis on ICA and FFRCT.
- Divided vessels into FFRCT > 0.80 (n=12) and FFRCT ≤ 0.80 (n=153) groups.
- Assessed vessel morphology, plaque characteristics, and left-ventricular (LV) parameters.
Main Results:
- LV myocardium parameters (wall thickness, LV mass, LV mass index) were higher in the FFRCT > 0.80 group.
- Vessel morphology and plaque characteristics did not significantly differ between groups.
- LV mass index was the strongest predictor of FFRCT > 0.80 (AUC 0.81, cut-off 66.5 g/m²).
Conclusions:
- Elevated LV mass is a primary cause for underestimating coronary artery stenosis severity via FFRCT in SOCAD.
- LV myocardium parameters are crucial for accurate FFRCT interpretation in SOCAD vessels.
Background:
In significant obstructive coronary artery disease (SOCAD), a mismatch in assessment of severity of coronary artery stenosis may occur between invasive coronary angiography (ICA) and computed tomography (CT) derived fractional flow reserve (FFRCT). The present study aimed to identify the factors giving an FFRCT > 0.80 and leading to an underestimation of coronary artery severity in SOCAD vessels.
Methods:
A total of 141 consecutive patients who underwent both CT angiography including FFRCT and ICA, the latter showing >75% coronary artery stenosis were evaluated. Vessels were divided into two groups according to FFRCT at the distal aspect of the vessel: FFRCT > 0.80 (n = 12) and FFRCT ≤ 0.80 (n = 153). Vessel morphology, plaque characteristics, left-ventricular (LV) wall thickness at each site of the myocardium, and LV mass were also assessed.
Results:
LV myocardium-related parameters including LV wall thickness (base, middle, apex, average, and maximal), LV mass, and LV mass index were higher in FFRCT > 0.80, whereas vessel-related parameters including, vessel morphology and plaque characteristics were not significantly different between >0.80 and < 0.80. Vessel morphology and plaque characteristics had no effect on FFRCT, whereas maximum LV wall thickness, LV mass, and LV mass index influenced FFRCT. LV mass index was the strongest predictor of distal FFRCT > 0.80 with an area under the curve of 0.81, and an optimal cut-off value of 66.5 g/m2 (sensitivity 77.8%, specificity 89.6%).
Conclusions:
The presence of a high LV mass is a major cause for underestimation of coronary artery severity on FFRCT in SOCAD vessels. LV myocardium-related parameters should be considered when interpreting numerical values of FFRCT.
