期刊
JACC-CARDIOVASCULAR IMAGING
卷 8, 期 1, 页码 1-10出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcmg.2014.11.002
关键词
coronary artery disease; coronary computed tomography angiography; coronary plaque; fractional flow reserve; myocardial ischemia
资金
- ICT R&D program of MSIP/IITP [10044910]
- National Institutes of Health [RO1HL115150, R0IEL118019]
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR000457] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R01HL118019, R01HL115150] Funding Source: NIH RePORTER
OBJECTIVES This study evaluated the association between atherosclerotic plague 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 CIA including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plague (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 plague <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) (C) 2015 by the American College of Cardiology Foundation..
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