Author + information
- Received July 28, 2017
- Revision received October 13, 2017
- Accepted October 31, 2017
- Published online January 17, 2018.
- Dong Hyun Yang, MDa,
- Soo-Jin Kang, MDb,
- Hyun Jung Koo, MDa,
- Jihoon Kweon, PhDb,
- Joon-Won Kang, MDa,
- Tae-Hwan Lim, MDa,
- Joonho Jung, PhDb,
- Namkug Kim, PhDc,
- June-Goo Lee, PhDd,
- Seungbong Han, PhDd,e,
- Jung-Min Ahn, MDb,
- Duk-Woo Park, MDb,
- Seung-Whan Lee, MDb,
- Cheol Whan Lee, MDb,
- Seong-Wook Park, MDb,
- Seung-Jung Park, MDb,
- Gary S. Mintz, MDf and
- Young-Hak Kim, MDb,∗ ()
- aDepartment of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- bDepartment of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- cDepartment of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- dBiomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- eDepartment of Applied Statistics, Gachon University, Gyeonggi-do, South Korea
- fCardiovascular Research Foundation, New York, New York
- ↵∗Address for correspondence:
Dr. Young-Hak Kim, Department of Cardiology, Asan Medical Center, 88, Olympic-ro 43-Gil, Songpa-gu, Seoul, Korea 138-736.
Objectives This study examined the incremental value of subtended myocardial mass (Vsub) as assessed by coronary computed tomography angiography (CTA) for identifying lesion-specific ischemia verified by invasive fractional flow reserve (FFR) in quantitative coronary CTA.
Background FFR is determined not only by coronary stenosis severity, but also by Vsub. One-step evaluation of combined Vsub and coronary lesion morphology may improve the accuracy of coronary CTA for identifying ischemia-producing lesions.
Methods A total of 246 intermediate coronary artery lesions (30% to 80% diameter stenosis) in 220 patients (mean age 61.7 years, 168 men) interrogated by FFR were retrospectively studied. Coronary CTA data were used to assess the Vsub by coronary artery stenosis, minimal lumen area (MLA), percentage of aggregated plaque volume (%APV), positive remodeling, and low-attenuation plaque. The ability of Vsub/MLA2 to discriminate lesions with FFR ≤0.80 was examined. Diagnostic performance, odds ratios, and category-less net reclassification improvements of coronary CTA parameters for FFR-verified (≤0.80) ischemia were evaluated. On-site computed tomography (CT) derived–FFR (CT-FFR) and quantitative coronary angiography (QCA) data were also compared.
Results Of 246 lesions, 84 (34.1%) showed an FFR ≤0.80. Vsub was independently associated with an FFR ≤0.80 (odds ratio: 1.04/1 cm3; p = 0.032) and showed incremental value over MLA. Vsub/MLA2 >4.16 was the best single parameter for discriminating an FFR ≤0.80 with 83.3% sensitivity and 67.9% specificity. The area under the curve (AUC) of Vsub/MLA2 >4.16 (0.80 [95% confidence interval: 0.75 to 0.85]) was better than that of MLA (change in [Δ]AUC: 0.069; p < 0.001), %APV (ΔAUC: 0.096; p = 0.017), and diameter stenosis of QCA (ΔAUC: 0.080; p = 0.037) and was comparable to that of CT-FFR (AUC 0.77; ΔAUC: 0.035; p = 0.304).
Conclusions Vsub is an independent determinant of an FFR ≤0.80. The mathematical index of Vsub/MLA2 >4.16 assessed by coronary CTA shows better diagnostic performance for the detection of ischemia-producing lesions than CT-derived MLA alone or %APV and QCA parameters and was comparable to that of on-site CT-FFR.
This work was supported by the Bio & Medical Technology Development Program through the Ministry of Education of the Republic of Korea and National Research Foundation of Korea (NRF-2017R1A2B3009800 and NRF-2016R1A1A1A05921207) and a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry for Health & Welfare, Republic of Korea (HI14C0517, HI15C1790 and HI17C1080). Dr. Mintz has received fellowship support and honoraria from Boston Scientific; has received grant support and honoraria from Volcano/Philips; has received grant support from St. Jude Medical/Abbott; and has received honoraria from ACIST and Indraredx. All other authors have reported that they have no relationships relevant to the contents of this article to disclose.
Drs. Yang and S.-J. Kang contributed equally to this work and are joint first authors.
- Received July 28, 2017.
- Revision received October 13, 2017.
- Accepted October 31, 2017.
- 2018 American College of Cardiology Foundation
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