Aggregate Plaque Volume by Coronary Computed Tomography Angiography Is Superior and Incremental to Luminal Narrowing for Diagnosis of Ischemic Lesions of Intermediate Stenosis Severity

作者：Nakazato Ryo; Shalev Aryeh; Doh Joon Hyung; Koo Bon Kwon; Gransar Heidi; Gomez Millie J; Leipsic Jonathon; Park Hyung Bok; Berman Daniel S; Min James K^*

来源：Journal of the American College of Cardiology, 2013, 62(5): 460-467.

DOI：10.1016/j.jacc.2013.04.062

• coronary artery disease
• coronary computed tomography angiography
• coronary plaque
• fractional flow reserve
• myocardial ischemia

Objectives This study examined the performance of percent aggregate plaque volume (%APV), which represents cumulative plaque volume as a function of total vessel volume, by coronary computed tomography angiography (CTA) for identification of ischemic lesions of intermediate stenosis severity. %26lt;br%26gt;Background Coronary lesions of intermediate stenosis demonstrate significant rates of ischemia. Coronary CTA enables quantification of luminal narrowing and %APV. %26lt;br%26gt;Methods We identified 58 patients with intermediate lesions (30% to 69% diameter stenosis) who underwent invasive angiography and fractional flow reserve. Coronary CTA measures included diameter stenosis, area stenosis, minimal lumen diameter (MLD), minimal lumen area (MLA) and %APV. %APV was defined as the sum of plaque volume divided by the sum of vessel volume from the ostium to the distal portion of the lesion. Fractional flow reserve %26lt;= 0.80 was considered diagnostic of lesion-specific ischemia. Area under the receiver operating characteristic curve and net reclassification improvement (NRI) were also evaluated. %26lt;br%26gt;Results Twenty-two of 58 lesions (38%) caused ischemia. Compared with nonischemic lesions, ischemic lesions had smaller MLD (1.3 vs. 1.7 mm, p = 0.01), smaller MLA (2.5 vs. 3.8 mm(2), p = 0.01), and greater %APV (48.9% vs. 39.3%, p %26lt; 0.0001). Area under the receiver operating characteristic curve was highest for %APV (0.85) compared with diameter stenosis (0.68), area stenosis (0.66), MLD (0.75), or MLA (0.78). Addition of % APV to other measures showed significant reclassification over diameter stenosis (NRI 0.77, p %26lt; 0.001), area stenosis (NRI 0.63, p = 0.002), MLD (NRI 0.62, p = 0.001), and MLA (NRI 0.43, p = 0.01). %26lt;br%26gt;Conclusions Compared with diameter stenosis, area stenosis, MLD, and MLA, % APV by coronary CTA improves identification, discrimination, and reclassification of ischemic lesions of intermediate stenosis severity.

• 出版日期2013-7-30