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Long-term prognostic implications of hemodynamic and plaque assessment using coronary CT angiography

Seokhun Yang1, Krista Lesina2, Joon-Hyung Doh3

  • 1Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.

Atherosclerosis
|March 5, 2023
PubMed

Insights

Coronary CT angiography (CTA) can predict long-term cardiovascular events. Hemodynamic and plaque characteristics derived from CTA provide independent prognostic value for target vessel failure and target lesion failure.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Interventional Cardiology

Background:

  • Coronary CT angiography (CTA) enables analysis of hemodynamic and plaque characteristics.
  • Understanding the long-term prognostic implications of these CTA-derived features is crucial for patient management.

Purpose of the Study:

  • To explore the long-term prognostic implications of hemodynamic and plaque characteristics obtained via coronary CT angiography (CTA).
  • To evaluate the collective influence of these parameters on clinical endpoints such as target vessel failure (TVF) and target lesion failure (TLF).

Main Methods:

  • 136 lesions in 78 vessels were analyzed using invasive fractional flow reserve (FFR) and CTA-derived FFR (FFRCT).
  • Parameters including FFRCT, wall shear stress (WSS), change in FFRCT (ΔFFRCT), total plaque volume (TPV), percent atheroma volume (PAV), and low-attenuation plaque volume (LAPV) were assessed.
  • Follow-up extended up to 10 years, with clinical endpoints of TVF and TLF evaluated.

Main Results:

  • Per-vessel analysis revealed PAV[V] and FFRCT[V] as independent predictors of TVF.
  • Per-lesion analysis identified WSS[L], LAPV[L], and ΔFFRCT[L] as independent predictors of TLF.
  • The combination of plaque and hemodynamic predictors significantly improved the 10-year predictability of TVF and TLF.

Conclusions:

  • Hemodynamic characteristics at the vessel and lesion level, along with plaque quantity (vessel-level) and composition (lesion-level) assessed by CTA, offer significant prognostic information.
  • These CTA-derived parameters provide independent and additive value for predicting long-term cardiovascular outcomes.
Abstract

Keywords:
Fractional flow reserveLong-term prognosisLow-attenuation plaquePercent atheroma volumeTotal plaque volumeWall shear stress

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