Impact of Coronary Remodeling on Fractional Flow Reserve
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In the early stage of coronary atherosclerosis, expansive remodeling compensates for plaque growth without affecting luminal dimensions or even results in a mild luminal enlargement.1,2 However, the impact of subclinical coronary artery disease progression on physiological parameters remains elusive. Coronary computed tomography angiography has emerged as a noninvasive method to evaluate lumen and plaque dimensions.3 In addition, vessel conductance can be assessed by the 3-dimensional reconstruction of the coronary lumen geometry and simulation of blood flow.4 This study aimed to evaluate the impact of coronary arterial remodeling and lumen dimensions on fractional flow reserve derived from coronary computed tomography angiography (FFRCT).
Serial coronary computed tomography angiography was performed in 24 patients with known coronary artery disease at baseline and the 54-month follow-up. Coronary vessels ≥2.0 mm in diameter with at least 10 mm in length were analyzed by an independent core laboratory (Cardialysis BV) using a validated software package (Medis QAngioCT). For the serial analyses, vessels were matched in length between baseline and follow-up. The FFRCT (HeartFlow, Inc) results are presented as the area under the virtual pullback curve (AUvPC), calculated by plotting the FFRCT value at every 10 mm versus length of the vessel (Figure, A). The …