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Advanced CT measures of coronary artery disease with intermediate stenosis in patients with severe aortic valve

Marcel C Langenbach1,2, Isabel L Langenbach3,4, Borek Foldyna4

  • 1Faculty of Medicine and University Hospital Cologne, Institute for Diagnostic and Interventional Radiology, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany. mlangenbach@mgh.harvard.edu.

European Radiology
|January 8, 2024
PubMed

Insights

CT-derived fractional flow reserve (CT-FFR) accurately identifies significant coronary lesions in patients with severe aortic valve stenosis. This non-invasive method surpasses anatomical assessment, plaque characteristics, and adipose tissue density for improved diagnostic capability.

Area of Science:

  • Cardiology
  • Radiology
  • Medical Imaging

Background:

  • Coronary artery disease (CAD) and severe aortic valve stenosis (AS) often coexist.
  • Assessing the hemodynamic significance of intermediate coronary stenoses pre-transcatheter aortic valve replacement (TAVR) using computed tomography angiography (CTA) is challenging.
  • This study evaluates advanced CT-derived metrics for improved lesion assessment.

Purpose of the Study:

  • To investigate the incremental value of CT-derived fractional flow reserve (CT-FFR), quantitative coronary plaque characteristics, and peri-coronary adipose tissue (PCAT) density.
  • To detect hemodynamically significant coronary lesions in patients with severe AS and intermediate stenoses.
  • To compare the diagnostic performance of these CT-derived parameters against invasive assessment.

Main Methods:

  • Patients with severe AS and intermediate coronary lesions (20-80% diameter stenosis) undergoing pre-TAVR CTA and invasive coronary angiography (ICA) with resting full-cycle ratio (RFR) were included.
  • CTA image analysis involved CT-FFR, quantitative plaque analysis, and PCAT density assessment.
  • Hemodynamic significance was defined by RFR ≤ 0.89.

Main Results:

  • CT-FFR demonstrated strong discriminatory capacity (AUC=0.89) for identifying hemodynamically significant lesions, outperforming anatomical assessment, plaque morphology, and PCAT density.
  • Plaque composition and PCAT density did not differ significantly between hemodynamically significant and non-significant lesions.
  • CT-FFR was the sole independent predictor of functionally significant lesions (OR 1.28, p<0.001), with a CT-FFR threshold of ≤ 0.80 achieving 88.4% diagnostic accuracy.

Conclusions:

  • CT-FFR is superior to CT anatomical, plaque morphology, and PCAT assessment for detecting functionally significant stenoses in patients with severe AS.
  • CT-FFR serves as a valuable non-invasive tool for hemodynamic assessment of intermediate coronary lesions in this population.
  • These findings may reduce the need for invasive coronary angiography prior to TAVR.
Abstract

Keywords:
Aortic valve stenosisCoronary angiographyCoronary artery diseaseFractional flow reserve (myocardial)Tomography (X-ray computed)

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