Advanced computed tomographic anatomical and morphometric plaque analysis for prediction of fractional flow reserve in intermediate coronary lesions

作者：Opolski Maksymilian P^*; Kepka Cezary; Achenbach Stephan; Pregowski Jerzy; Kruk Mariusz; Staruch Adam D; Kadziela Jacek; Ruzyllo Witold; Witkowski Adam

来源：European Journal of Radiology, 2014, 83(1): 135-141.

DOI：10.1016/j.ejrad.2013.10.005

• Coronary computed tomography angiography
• Fractional flow reserve
• Intermediate coronary stenosis

Objective: To determine the application of advanced coronary computed tomography angiography (CCTA) plaque analysis for predicting invasive fractional flow reserve (FFR) in intermediate coronary lesions.
Methods: Sixty-one patients with 71 single intermediate coronary lesions (>= 50-80% stenosis) on CCTA prospectively underwent coronary angiography and FFR. Advanced anatomical and morphometric plaque analysis was performed based on CCTA data set to determine optimal criteria for significant flow impairment. A significant stenosis was defined as FFR <= 0.80.
Results: FFR averaged 0.85 +/- 0.09, and 19 lesions (27%) were functionally significant. FFR correlated with minimum lumen area (MLA) (r = 0.456, p < 0.001), minimum lumen diameter (MLD) (r = 0.326, p = 0.006), reference lumen diameter (RLD) (r = 0.245, p = 0.039), plaque burden (r = -0.313, p = 0.008), lumen area stenosis (r = -0.305, p = 0.01), lesion length (r = -0.692, p < 0.001), and plaque volume (r = -0.668, p < 0.001). There was no relationship between FFR and CCTA morphometric plaque parameters. By multivariate analysis the independent predictors of FFR were lesion length (beta = -0.581, p < 0.001), MLA (beta = 0.360, p = 0.041), and RLD (beta = -0.255, p = 0.036). The optimal cutoffs for lesion length, MLA, MLD, RLD, and lumen area stenosis were >18.5 mm, <= 3.0 mm(2), <= 2.1 mm, <= 3.2 mm, and >69%, respectively (max. sensitivity: 100% for MLA, max. specificity: 79% for lumen area stenosis).
Conclusions: CCTA predictors for FFR support the mathematical relationship between stenosis pressure drop and coronary flow. CCTA could prove to be a useful rule-out test for significant hemodynamic effects of intermediate coronary stenoses.

• 出版日期2014-1