Related Experiment Video
Updated: Jan 6, 2026
Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
Published on: January 15, 2022
Clinical implications of improved risk prediction of continuous FFRCT by accounting for adverse coronary
Afiachukwu Onuegbu1, Jonathan Weber1, Karli Pipitone1
1DeMatteis Cardiovascular Institute, St. Francis Hospital & Heart Center, 100 Port Washington Blvd, 11576, Roslyn, NY, USA.
Insights
Fractional flow reserve computed from CT angiography (FFRCT) shows a continuous risk for acute coronary syndrome (ACS). Incorporating adverse plaque features improves ACS prediction, especially for borderline FFRCT values.
Area of Science:
- Cardiovascular Imaging
- Interventional Cardiology
- Computational Fluid Dynamics
Background:
- Fractional flow reserve computed from CT angiography (FFRCT) is a key tool for assessing coronary artery disease.
- Current risk stratification often dichotomizes FFRCT values, potentially overlooking nuanced risk information.
Purpose of the Study:
- To investigate the risk continuum of FFRCT in relation to acute coronary syndrome (ACS).
- To evaluate the predictive value of FFRCT when combined with coronary atherosclerotic features for ACS risk.
Main Methods:
- Analysis of coronary computed tomography angiography (CCTA) and FFRCT in ambulatory patients.
- Classification of adverse plaque features (mixed, non-calcified, diffuse).
- Long-term follow-up for ACS events (myocardial infarction, urgent revascularization).
Main Results:
- A continuous increase in coronary stenosis and adverse plaque features was observed across decreasing FFRCT categories.
- Each 0.05 unit decrease in FFRCT correlated with an 18% increase in ACS risk.
- Combining FFRCT with adverse coronary features significantly improved ACS risk predictability.
Conclusions:
- FFRCT demonstrates a risk continuum for ACS, supporting its use beyond dichotomized assessments.
- Accounting for adverse coronary atherosclerotic features enhances FFRCT's predictive power for ACS.
- This approach has clinical implications for managing patients with borderline FFRCT values.
Purpose:
Fractional flow reserve (FFR) derived from coronary computed tomography angiography (FFRCT) is commonly used as a dichotomized index for risk stratification. We investigated the risk continuum of FFRCT on acute coronary syndrome (ACS) and its predictive value associated with coronary atherosclerotic features.
Methods:
Consecutive ambulatory patients who underwent coronary computed tomography angiography (CCTA) with subsequent FFRCT analysis by HeartFlow were included. Adverse plaque features were classified as mixed, non-calcified or diffuse plaque. The clinical outcome was the ACS spectrum of acute myocardial infarction or urgent revascularization due to unstable angina.
Results:
Among 1304 subjects included, 3912 vessels were analyzed. There was a gradual increase in the frequency of coronary stenosis [Formula: see text]50% and adverse plaque features in FFRCT categories of >0.90, 0.86-0.90, 0.81-0.85, 0.75-0.80 and <0.75 respectively (both p < 0.0001). During the mean follow-up period of 3.7 ± 1.8 years, 75 cases of ACS occurred. For every 0.05 unit decrease in FFRCT, there was an 18% increase in ACS risk (adjusted hazard ratio [HR] 1.18, 95% confidence interval [CI] 1.10-1.26). An additional 14% (HR 1.14, 95% CI 1.06-1.23) and 16% (HR 1.16, 95% CI 1.08-1.24) increase in ACS risk when coronary stenosis ≥50% or adverse plaque was present respectively. Likelihood ratio tests demonstrated improved ACS risk predictability by combining adverse coronary features with FFRCT.
Conclusion:
Our results demonstrated a risk continuum of FFRCT for ACS supporting the value of FFRCT beyond dichotomized evaluation. ACS predictability from FFRCT was improved by accounting for adverse coronary atherosclerotic features which may have important clinical implications when FFRCT values are in borderline range.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:26Coronary Artery Disease IV: Preventive Measures
01:26Atherosclerosis III: Management
01:27Coronary Artery Disease V: Interprofessional Care
01:26Coronary Artery Disease II: Pathophysiology