Abstract 14669: Predictive Value of Lesion-Associated Parameters from Coronary Computed Tomography Angiography for Hemodynamically Significant Stenoses Confirmed by Invasive Fractional Flow Reserve
Background: The ability of coronary computed tomography angiography (cCTA) to gauge lesion-specific ischemia is limited. Recent studies proposed several parameters, such as morphologic indices (lesion length/minimal lumen diameter4, LL/MLD4; aggregate plaque volume, %APV) and measures of intracoronary contrast gradients (transluminal attenuation gradient, TAG; corrected contrast opacification, CCO), to mitigate this limitation. We aimed at evaluating and comparing parameters derived from routine cCTA for gauging the hemodynamic significance of stenosis, using fractional flow reserve (FFR) as the reference standard.
Methods and Results: Forty-nine patients who had undergone cCTA and invasive angiography with FFR within 3 months were included. An experienced observer visually assessed all cCTA studies and derived LL/MLD4, %APV, TAG, CCO and other measures characterizing the lesion of interest, including LL, MLD, minimal lumen area (MLA), diameter stenosis (%DS), area stenosis (%AS), and remodeling index. Lesion-specific ischemia was considered with FFR <0.8. Among 56 lesions, 13 were significant by FFR. On univariate analysis, LL, MLD, %DS, LL/MLD4, TAG, and CCO showed discriminatory power regarding lesion-specific ischemia. The area under the receiver operating characteristics curve (AUC) was significantly greater for LL/MLD4 (0.91) compared with MLD (0.80, p=0.01), TAG (0.75, p=0.03), %DS (0.75, p=0.04), LL (0.74, p=0.04), and CCO (0.81), although the latter did not reach statistical significance (p=0.18). On multivariate regression, LL/MLD4 was the only independent predictor of lesion specific ischemia (odds ratio 2.02, p=0.01). Also, LL/MLD4 compared favorably to visual cCTA assessment (Figure 1).
Conclusions: Our data suggest that LL/MLD4 derived from routine cCTA can enhance the diagnostic performance for detecting lesion-specific ischemia and provides incremental value over other described parameters.
Author Disclosures: M. Renker: None. R. Wang: None. F.G. Meinel: None. S. Baumann: None. J.D. Rier: None. R.R. Bayer: None. H. Nef: None. C.W. Hamm: None. D.H. Steinberg: None. U.J. Schoepf: Other Research Support; Significant; UJS is a consultant for and receives research support from Bayer, Bracco, GE, Medrad, and Siemens. The other authors have no potential conflicts of interest to disclose.
- © 2014 by American Heart Association, Inc.