Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5984944 | Journal of Cardiovascular Computed Tomography | 2015 | 7 Pages |
â¢Quantitative stenosis parameters can be assessed by routine coronary CT angiography.â¢CT-derived stenosis parameters can enhance detection of lesion-specific ischemia.â¢Lesion length/minimal lumen diameter4 may be superior to other proposed predictors of lesion-specific ischemia.
ObjectiveTo comprehensively evaluate quantitative parameters derived from routine coronary CT angiography (cCTA) for predicting lesion-specific ischemia in comparison to invasive fractional flow reserve (FFR).BackgroundThe ability of cCTA to gauge lesion-specific ischemia is limited. Several quantitative parameters have been proposed to enhance the specificity of cCTA, such as morphologic indices (lesion length/minimal lumen diameter4 [LL/MLD4]; percentage aggregate plaque volume [%APV]) and a measure of intracoronary contrast gradients (corrected coronary opacification [CCO]).MethodsForty-nine patients who had undergone cCTA followed by FFR within 3Â months were included. An experienced observer visually assessed all cCTA studies and derived multiple measures characterizing the lesion of interest, including LL, MLD, minimal lumen area (MLA), LL/MLD4, remodeling index, %APV, and CCO. Lesion-specific ischemia was considered with FFR <0.8.ResultsAmong 56 lesions, 13 were flow-obstructing by FFR. On univariate analysis, LL, MLD, LL/MLD4, and CCO showed discriminatory power. The area under the curve of LL/MLD4 (0.909) was significantly greater compared with MLD (0.802, PÂ =Â 0.014), LL (0.739, PÂ =Â 0.041), and CCO (0.809), although the latter did not reach statistical significance (PÂ =Â 0.175). On multivariate regression, LL/MLD4 was the only independent predictor of lesion-specific ischemia (odds ratio 2.021, PÂ =Â 0.001). Moreover, LL/MLD4 compared favorably to visual cCTA evaluation.ConclusionLL/MLD4 derived from routine cCTA can enhance the detection of lesion-specific ischemia and may be superior to other described quantitative parameters.