Author + information
- Received November 5, 2018
- Revision received May 30, 2019
- Accepted June 6, 2019
- Published online August 14, 2019.
- Roel S. Driessen, MDa,
- Guus A. de Waard, MDa,
- Wijnand J. Stuijfzand, MDa,
- Pieter G. Raijmakers, MD, PhDb,
- Ibrahim Danad, MDa,
- Michiel J. Bom, MDa,
- James K. Min, MDc,
- Jonathon A. Leipsic, MDd,
- Amir Ahmadi, MDe,
- Peter M. van de Ven, PhDf,
- Juhani Knuuti, MD, PhDg,
- Albert C. van Rossum, MD, PhDa,
- Justin E. Davies, MD, PhDh,
- Niels van Royen, MD, PhDa,
- Jagat Narula, MD, PhDe and
- Paul Knaapen, MD, PhDa,∗ ()
- aDepartment of Cardiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- bDepartment of Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- cInstitute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, New York
- dDepartment of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- eDivision of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
- fDepartment of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- gTurku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
- hDepartment of Cardiology, Imperial College, London, United Kingdom
- ↵∗Address for correspondence:
Prof. Dr. Paul Knaapen, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Objectives The current substudy of the PACIFIC (Prospective Comparison of Cardiac PET/CT, SPECT/CT Perfusion Imaging and CT Coronary Angiography With Invasive Coronary Angiography) trial explores the impact of computed tomography (CT)–derived unfavorable plaque features on both hyperemic and non-hyperemic flow indices.
Background Next to lesion severity, plaque vulnerability as assessed using coronary CT angiography affects fractional flow reserve (FFR), which is associated with imminent acute coronary syndromes. Instantaneous wave-free ratio (iFR) has recently emerged as an alternative for FFR to interrogate coronary lesions for ischemia. It is, however, unknown whether vasodilator-free assessment with iFR is associated with plaque stability similarly as FFR.
Methods Of 120 patients (62% men, age 58.3 ± 8.6 years) with suspected coronary artery disease, 257 vessels were prospectively evaluated. Each patient underwent 256-slice coronary CT angiography to assess stenosis severity and plaque features (positive remodeling [PR], low attenuation plaque [LAP], spotty calcification [SC], and napkin ring sign [NRS]), as well as intracoronary pressure measurements (FFR, iFR, Pd/Pa, and pressure ratio during adenosine within the wave-free period [iFRa]). CT-derived plaque characteristics were related to these invasive pressure measurements.
Results Atherosclerotic plaques were present in 170 (66%) coronary arteries. On a per-vessel basis, luminal stenosis severity was significantly associated with impaired FFR, iFR, Pd/Pa, and iFRa. Multivariable analysis revealed that FFR and iFR were independently related to ≥70% stenosis (−0.10, p < 0.001 and −0.09, p = 0.003, respectively) and plaque volume (-0.02, p = 0.020 and -0.02, p = 0.030, respectively). Additionally, PR and SC were also independent predictors of an impaired FFR (−0.10, p < 0.001 and −0.07, p = 0.021, respectively), but adverse plaque characteristics were not independently related to the vasodilator-free iFR.
Conclusions CT-derived vulnerable plaque characteristics are independently associated with hyperemic flow indices as assessed with FFR and iFRa, but not with non-hyperemic indices such as iFR and Pd/Pa. These findings suggest that the effects of hyperemia on pressure-derived indices might depend not only on hemodynamic stenosis severity but also on plaque characteristics.
- adverse plaque characteristics
- coronary artery disease
- coronary computed tomography angiography
- fractional flow reserve
- instantaneous wave-free ratio
Dr. Min has served as a consultant to Abbott Vascular; has served on the Scientific Advisory Board of Arineta and GE Healthcare; has received funding from the Dalio Foundation, the National Institutes of Health, and GE Healthcare; and has an equity interest in MDDX and Cleerly. Dr. Leipsic has received research grants from GE Healthcare; and has served as a consultant to and holds stock options in Circle CVI and HeartFlow. Dr. Davies holds patents pertaining to the iFR technology; has served as a consultant for Philips Volcano; and has received research grants from Philips Volcano. Dr. van Royen has received research grants from Abbott, AstraZeneca, Biotronik, and Philips Healthcare; and has served on the Advisory Board of Boston Scientific, Medtronic, and Amgen. Dr. Knaapen received unrestricted research grants from HeartFlow. Dr. Knuuti has been a study consultant for GE Healthcare and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Todd Villines, MD, served as Guest Editor for this paper.
- Received November 5, 2018.
- Revision received May 30, 2019.
- Accepted June 6, 2019.
- 2019 American College of Cardiology Foundation