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Coronary Artery Vorticity to Predict Functional Plaque Progression in Participants with Type 2 Diabetes Mellitus
Nobuo Tomizawa1, Shinichiro Fujimoto1, Tomoya Mita1
1From the Department of Radiology (N.T., R.F., K.K.K., S.A.), Department of Cardiovascular Biology and Medicine (S.F., D.T., Y.N., A.K., Y.K., K.T., M.H., T. Minamino), and Department of Diabetes, Endocrinology, and Metabolism (T. Mita, M.K., H.W.), Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan.
Insights
Vorticity better predicts functional plaque progression in type 2 diabetes patients than high-risk plaque and lesion length. This finding improves understanding of coronary artery disease progression.
Area of Science:
- Cardiovascular Imaging
- Biomedical Engineering
- Computational Fluid Dynamics
Background:
- Type 2 diabetes mellitus is associated with increased risk of coronary artery disease.
- Assessing functional plaque progression is crucial for managing cardiovascular risk.
- Current methods like high-risk plaque (HRP) and lesion length (LL) have limitations in predicting progression.
Purpose of the Study:
- To evaluate if vorticity can predict functional plaque progression more effectively than HRP and LL in patients with type 2 diabetes.
- To compare the predictive performance of vorticity against established plaque assessment metrics.
Main Methods:
- A prospective study involving 61 participants with type 2 diabetes and 20%-70% coronary stenosis.
- Serial coronary CT angiography was performed over 2 years.
- Vorticity was calculated using mesh-free simulation, and functional progression was defined by a decrease in CT fractional flow reserve > 0.05.
Main Results:
- Vessels with functional progression exhibited significantly higher distal vorticity (984 sec⁻¹ vs 443 sec⁻¹; P < .001).
- Vorticity demonstrated a higher area under the receiver operating characteristic curve (0.91 vs 0.69; P < .01) compared to HRP and LL.
- The diagnostic accuracy of vorticity (85%) surpassed that of HRP and LL (72%) for predicting functional progression (P = .004).
Conclusions:
- Vorticity is a superior predictor of functional plaque progression in individuals with type 2 diabetes mellitus.
- This finding suggests vorticity could be a valuable tool for risk stratification and personalized treatment strategies in coronary artery disease.
Purpose:
To investigate whether vorticity could predict functional plaque progression better than high-risk plaque (HRP) and lesion length (LL) in individuals with type 2 diabetes mellitus.
Materials And Methods:
This single-center prospective study included 61 participants (mean age, 61 years ± 9 [SD]; 43 male participants) who underwent serial coronary CT angiography at 2 years, with 20%-70% stenosis at initial CT between October 2015 and March 2020. The number of the following HRP characteristics was recorded: low attenuation, positive remodeling, spotty calcification, and napkin-ring sign. Vorticity was calculated using a mesh-free simulation. A decrease in CT fractional flow reserve larger than 0.05 indicated functional progression. Models using HRP and LL and vorticity were compared using receiver operating characteristic curve analysis.
Results:
Of the 94 vessels evaluated, 25 vessels (27%) showed functional progression. Vessels with functional progression showed higher vorticity at distal stenosis (984 sec-1; IQR: 730-1253 vs 443 sec-1; IQR: 295-602; P < .001) than vessels without progression. The area under the receiver operating characteristic curve of vorticity (0.91; 95% CI: 0.84, 0.97) was higher than that of HRP and LL (0.69; 95% CI: 0.56, 0.82; P < .01). Diagnostic accuracy of vorticity (85%; 80 of 94 vessels; 95% CI: 76, 92) was higher than that of HRP and LL (72%; 68 of 94 vessels; 95% CI: 62, 81; P = .004).
Conclusion:
In participants with type 2 diabetes mellitus, vorticity at distal stenosis was a better predictor of functional plaque progression than HRP and LL.Keywords: Coronary Artery, Vorticity, Functional Plaque Progression, Type 2 Diabetes, Vasculature, CT Angiography, Computational Fluid Dynamics, Fractional Flow Reserve Supplemental material is available for this article. © RSNA, 2023.
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