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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography
Marta Belmonte1, Pasquale Paolisso2, Emanuele Gallinoro2
1Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
Insights
Combining coronary computed tomography angiography (CCTA) diameter stenosis (DS) with vessel-specific plaque features improves identification of coronary artery ischemia. This integrated approach enhances diagnostic accuracy compared to DS alone.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Medical Diagnostics
Background:
- Discrepancies exist between coronary computed tomography angiography (CCTA) stenosis severity and actual ischemia, potentially influenced by coronary vessel type.
- Coronary plaque morphology is known to correlate with the presence of ischemia.
- Investigating vessel-specific correlations between CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) is crucial.
Purpose of the Study:
- To evaluate the vessel-specific correlation between CCTA-derived DS and invasive FFR.
- To explore if integrating morphological plaque features, stratified by vessel type, enhances the prediction of vessel-specific ischemia.
- To determine if this integrated approach improves diagnostic accuracy in identifying functionally significant coronary artery disease.
Main Methods:
- An observational cohort study included patients with suspected coronary artery disease undergoing CCTA and invasive coronary angiography with FFR.
- Vessels with DS ≥ 50% at CCTA were analyzed for plaque morphology using validated software.
- Coronary arteries were stratified into LAD, LCX, and RCA; multivariable logistic regression identified vessel-specific predictors of ischemia (FFR ≤ 0.80).
Main Results:
- In 224 vessels (61% LAD, 19% LCX, 20% RCA) with DS ≥ 50%, ischemia (FFR ≤ 0.80) was more frequent in LAD (67.2%) vs. LCX (43.2%) and RCA (44.2%).
- A significant correlation between DS and FFR was found only in the LAD.
- Vessel-specific predictors included percent atheroma volume for LAD, non-calcified plaque volume for LCX, and lumen volume for RCA; integration improved AUC from 0.51-0.63 to 0.76-0.80.
Conclusions:
- Integrating CCTA-derived DS with vessel-specific morphological plaque features significantly enhances the prediction of coronary artery ischemia.
- This combined approach offers superior diagnostic yield compared to DS alone.
- Improved diagnostic accuracy may optimize patient selection for invasive procedures like catheterization.
Background:
Discrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia.
Methods:
Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ≥ 50 % at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80.
Results:
The study population consisted of 192 patients, of whom 224 vessels (61 % LAD, 19 % LCX, 20 % RCA) had lesions with DS ≥ 50 % interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 % vs 43.2 % and 44.2 %, respectively, p = 0.018). A significant correlation between DS and FFR was observed only in LAD (p = 0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 %) for LAD, non-calcified plaque volume (threshold >130 mm3) for LCX, and lumen volume (threshold <844 mm3) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76-0.80).
Conclusions:
Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients' referral to the catheterization laboratory.
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