Author + information
- Received September 21, 2017
- Revision received November 7, 2017
- Accepted November 8, 2017
- Published online April 2, 2018.
- Amir Ahmadi, MDa,b,
- Jonathon Leipsic, MDb,
- Kristian A. Øvrehus, MDc,
- Sara Gaur, MDc,
- Emilia Bagiella, PhDa,
- Brian Ko, MDd,
- Damini Dey, PhDe,
- Gina LaRocca, MDa,
- Jesper M. Jensen, MDc,
- Hans Erik Bøtker, MDc,
- Stephan Achenbach, MDf,
- Bernard De Bruyne, MD, PhDg,
- Bjarne L. Nørgaard, MD, PhDc and
- Jagat Narula, MD, PhDa,∗ ()
- aDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- bDivision of Cardiology, Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- cDivision of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- dDivision of Cardiology, Monash University, Melbourne, Australia
- eDivision of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
- fDivision of Cardiology, University of Erlangen-Nuremberg, Erlangen, Germany
- gDivision of Cardiology, Cardiovascular Center Aalst, Aalst, Belgium
- ↵∗Address for correspondence:
Dr. Jagat Narula, Icahn School of Medicine at Mount Sinai, 1190 Fifth Avenue, GP-1 West, N-125, New York, New York 10029.
Objectives The aims of the present study were: 1) to investigate the contribution of the extent of luminal stenosis and other lesion composition-related factors in predicting invasive fractional flow reserve (FFR); and 2) to explore the distribution of various combinations of morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR.
Background In patients with stable ischemic heart disease, FFR-guided revascularization, as compared with medical therapy alone, is reported to improve outcomes. Because morphological characteristics are the basis of plaque rupture and acute coronary events, a relationship between FFR and lesion characteristics may exist.
Methods This is a subanalysis of NXT (HeartFlowNXT: HeartFlow Analysis of Coronary Blood Flow Using Coronary CT Angiography), a prospective, multicenter study of 254 patients (age 64 ± 10 years, 64% male) with suspected stable ischemic heart disease; coronary computed tomography angiography including plaque morphology assessment, invasive angiography, and FFR were obtained for 383 lesions. Ischemia was defined by invasive FFR ≤0.80. Computed tomography angiography–defined morphological characteristics of plaques and their vascular location were used in univariate and multivariate analyses to examine their predictive value for invasive FFR. The distribution of various combinations of plaque morphological characteristics and the severity of stenosis among lesions demonstrating normal and abnormal FFR were examined.
Results The percentage of luminal stenosis, low-attenuation plaque (LAP) or necrotic core volume, left anterior descending coronary artery territory, and the presence of multiple lesions per vessel were the predictors of FFR. When grouped on the basis of degree of luminal stenosis, FFR-negative lesions had consistently smaller LAP volumes compared with FFR-positive lesions. The distribution of plaque characteristics in lesions with normal and abnormal FFR demonstrated that whereas FFR-negative lesions excluded likelihood of stenotic plaques with moderate to high LAP volumes, only one-third of FFR-positive lesions demonstrated obstructive plaques with moderate to high LAP volumes.
Conclusions In addition to the severity of luminal stenosis, necrotic core volume is an independent predictor of FFR. The distribution of plaque characteristics among lesions with varying luminal stenosis and normal and abnormal FFR may explain the outcomes associated with FFR-guided therapy.
- coronary artery stenosis
- myocardial ischemia
- percutaneous coronary intervention
- stable ischemic heart disease
- vulnerable plaque
Dr. Leipsic is a consultant for and has received stock options from Circle CVI and HeartFlow; and has received fellowship support from GE Healthcare. Dr. Ko has received speaker fees from St. Jude Medical, Merck Sharpe & Dohme, Novartis, Bristol-Myers Squibb, and Specialised Therapeutics. Dr. Dey may receive royalties for software licenses from Cedars-Sinai Medical Center. Dr. Jensen has received a speaker honorarium from Bracco Imaging. Dr. De Bruyne has served as an institutional consultant for Abbott, Boston Scientific Corporation, and Opsens. Dr. Nørgaard’s institution has received unrestricted research grants from HeartFlow and Siemens. Dr. Botker’s institution has received an unrestricted research grant from HeartFlow.
- Received September 21, 2017.
- Revision received November 7, 2017.
- Accepted November 8, 2017.