Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve

Hyung-Bok Park; Ran Heo; Bríain Ó Hartaigh; Iksung Cho; Heidi Gransar; Ryo Nakazato; Jonathon Leipsic; G B John Mancini; Bon-Kwon Koo; Hiromasa Otake; Matthew J Budoff; Daniel S Berman; Andrejs Erglis; Hyuk-Jae Chang; James K Min

doi:10.1016/j.jcmg.2014.11.002

Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: a direct comparison to fractional flow reserve

JACC Cardiovasc Imaging. 2015 Jan;8(1):1-10. doi: 10.1016/j.jcmg.2014.11.002.

Authors

Affiliations

¹ Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea; Cardiovascular Center, Myongji Hospital, Goyang, Korea.
² Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York; Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
³ Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
⁴ Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
⁵ Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan.
⁶ Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.
⁷ Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁸ Department of Medicine, Seoul National University Hospital, Seoul, South Korea.
⁹ Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
¹⁰ Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California.
¹¹ Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia.
¹² Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
¹³ Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York. Electronic address: jkm2001@med.cornell.edu.

Abstract

Objectives: This study evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary computed tomographic angiography (CTA), and lesion ischemia by fractional flow reserve (FFR).

Background: FFR is the gold standard for determining lesion ischemia. Although APCs by CTA-including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP), and spotty calcification (SC)-are associated with future coronary syndromes, their relationship to lesion ischemia is unclear.

Methods: 252 patients (17 centers, 5 countries; mean age 63 years; 71% males) underwent coronary CTA, with FFR performed for 407 coronary lesions. Coronary CTA was interpreted for <50% and ≥50% stenosis, with the latter considered obstructive. APCs by coronary CTA were defined as: 1) PR, lesion diameter/reference diameter >1.10; 2) LAP, any voxel <30 Hounsfield units; and 3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and net reclassification improvement of APCs for lesion ischemia, defined by FFR ≤0.8, were analyzed.

Results: By FFR, ischemia was present in 151 lesions (37%). %APV was associated with a 50% increased risk of ischemia per 5% additional APV. PR, LAP, and SC were associated with ischemia, with a 3 to 5 times higher prevalence than in nonischemic lesions. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 (OR: 4.0, p < 0.001) and ≥2 (OR: 12.1, p < 0.001) APCs. These findings were APC dependent, with PR (OR: 5.3, p < 0.001) and LAP (OR: 2.1, p = 0.038) associated with ischemia, but not SC. When examined by stenosis severity, PR remained a predictor of ischemia for all lesions, whereas %APV and LAP were associated with ischemia for only ≥50%, but not for <50%, stenosis.

Conclusions: %APV and APCs by coronary CTA improve identification of coronary lesions that cause ischemia. PR is associated with all ischemia-causing lesions, whereas %APV and LAP are only associated with ischemia-causing lesions ≥50%. (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography; NCT01233518).

Keywords: coronary artery disease; coronary computed tomography angiography; coronary plaque; fractional flow reserve; myocardial ischemia.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Angiography*
Coronary Occlusion / diagnosis*
Female
Fractional Flow Reserve, Myocardial*
Humans
Male
Middle Aged
Plaque, Atherosclerotic / diagnostic imaging*
Tomography, X-Ray Computed*

Associated data

ClinicalTrials.gov/NCT01233518

Abstract

Publication types

MeSH terms

Associated data

Grants and funding