Advanced analyses of computed tomography coronary angiography can help discriminate ischemic lesions

Computed tomography coronary angiography (CTCA) image analysis enables plaque characterization and non-invasive fractional flow reserve (FFR) calculation. We analyzed various parameters derived from CTCA images and evaluated their associations with ischemia. 49 (61 lesions) patients underwent CTCA a...

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Published in:	International journal of cardiology Vol. 267; pp. 208 - 214
Main Authors:	Zhang, Jun-Mei, Shuang, Dongsi, Baskaran, Lohendran, Wu, Weijun, Teo, Soo-Kng, Huang, Weimin, Gobeawan, Like, Allen, John Carson, Tan, Ru San, Su, Xi, Ismail, Nasrul Bin, Wan, Min, Su, Boyang, Zou, Hua, Low, Ris, Zhao, Xiaodan, Chi, Yanling, Zhou, Jiayin, Su, Yi, Lomarda, Aileen Mae, Chin, Chee Yang, Fam, Jiang Ming, Keng, Felix Yung Jih, Wong, Aaron Sung Lung, Tan, Jack Wei Chieh, Yeo, Khung Keong, Wong, Philip En Hou, Chin, Chee Tang, Ho, Kay Woon, Yap, Jonathan, Kassab, Ghassan S., Chua, Terrance, Koh, Tian Hai, Tan, Swee Yaw, Lim, Soo Teik, Zhong, Liang
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier B.V 15-09-2018
Subjects:	Aged China - epidemiology Computed Tomography Angiography - methods Coronary Artery Disease - diagnosis Coronary Artery Disease - epidemiology Coronary Artery Disease - physiopathology Coronary Vessels - diagnostic imaging Dimensional Measurement Accuracy Female Fractional Flow Reserve, Myocardial Humans Male Middle Aged Plaque, Atherosclerotic - diagnostic imaging Predictive Value of Tests Retrospective Studies Singapore - epidemiology China Singapore
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Summary:	Computed tomography coronary angiography (CTCA) image analysis enables plaque characterization and non-invasive fractional flow reserve (FFR) calculation. We analyzed various parameters derived from CTCA images and evaluated their associations with ischemia. 49 (61 lesions) patients underwent CTCA and invasive FFR. Lesions with diameter stenosis (DS) ≥ 50% were considered obstructive. CTCA image processing incorporating analytical and numerical methods were used to quantify anatomical parameters of lesion length (LL) and minimum lumen area (MLA); plaque characteristic parameters of plaque volume, low attenuation plaque (LAP) volume, dense calcium volume (DCV), normalized plaque volume (NP Vol), plaque burden, eccentricity index and napkin-ring (NR) sign; and hemodynamic parameters of resistance index, stenosis flow reserve (SFR) and FFRB. Ischemia was defined as FFR ≤ 0.8. Plaque burden and plaque volume were inversely related to FFR. Multivariable logistic regression analysis identified the best anatomical, plaque and hemodynamic predictors, respectively, as DS (≥50% vs <50%; OR: 8.0; 95% CI: 1.6–39.4), normalized plaque volume (NP Vol) (≥4.3 vs <4.3; OR: 3.9; 95% CI: 1.1–14.0) and NR Sign (0 vs 1; OR: 13.6; 95% CI: 1.3–146.1), and FFRB (≤0.8 vs >0.8; OR: 44.4; 95% CI: 8.8–224.8). AUC increased from 0.70 with DS as the sole predictor to 0.81 after adding NP Vol and NR Sign; further addition of FFRB increased AUC to 0.93. Normalized plaque volume, napkin-ring derived from plaque analysis, and FFRB from numerical simulations on CTCA images substantially improved discrimination of ischemic lesions, compared to assessment by DS alone. •Quantification of FFRB with reduced order CFD and novel boundary conditions•Quantification of normalized plaque volume and napkin-ring sign semi-automatically•FFRB and plaque property are quantified in Asian population.•Combination of FFRB and plaque property achieved an incremental diagnostic value
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0167-5273 1874-1754
DOI:	10.1016/j.ijcard.2018.04.020