Abstract 15139: Coronary Arterial Stenosis Assessment versus Different Coronary Atherosclerotic Plaque Burden Indices by Computed Tomography Angiography for Detecting Hemodynamically Significant Coronary Artery Disease - Insights From the CORE320 International Study
Purpose: The aim of this study is to investigate the diagnostic performance of semi-automatically derived indices of coronary atherosclerotic plaque burden by coronary CT angiography (CTA) for assessment of flow-limiting stenosis using a combined outcome of Quantitative Coronary Angiography (QCA) and Single-Photon Emission Computed Tomography (SPECT) as the reference.
Methods: Three-hundred-seventy-three patients with suspected CAD referred for invasive angiography in the CORE320 multicenter study underwent a cardiac 320-slice CT scanning. Per-patient coronary atherosclerotic plaque burden was assessed using a novel arterial contour detection algorithm (MEDIS™, Netherlands), by subtracting lumen volume from vessel wall volume for the entire coronary tree using a 19-segment coronary model. To estimate severity of plaque burden, we used three indexed parameters: 1) Length normalized total atheroma volume (lenght normTAV) - total plaque volume)/(total coronary length); 2) Normalized total atheroma volume (TAVnorm) - (total plaque volume)/(total coronary length) x mean coronary length in study population); 3) percent atheroma volume (PAV) - (total plaque volume)/(total vessel volume) x 100. Area under Receiver-Operation Characteristics Curve (AUC) estimated the diagnostic accuracy of these indices to predict flow-limiting stenosis, defined as the presence of at least one >50% stenosis with related perfusion deficit by SPECT.
Results: The diagnostic accuracy of coronary plaque burden assessed by PAV was similar to coronary CTA to predict flow-limiting stenosis (AUC 0,79 [0.75-0.83] vs 0,82 [0.77-0.86] respectively, p= 0.28). Plaque burden assessed by length normTAV and TAVnorm had the same diagnostic performance to predict disease (AUC 0.73 [0.68 - 0.77]), being inferior to coronary CTA (p = 0.002).
Conclusions: Semi-automatically derived coronary atherosclerotic plaque burden index by CTA offers robust information to predict flow-limiting stenosis. Percent atheroma volume had the best performance to predict flow-limiting stenosis among all plaque burden indices, with no difference when compared to CTA stenosis assessment.
- © 2013 by American Heart Association, Inc.