TY - JOUR
T1 - Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain
T2 - Subgroup analysis of the ROMICAT II trial
AU - Ferencik, Maros
AU - Lu, Michael T.
AU - Mayrhofer, Thomas
AU - Puchner, Stefan B.
AU - Liu, Ting
AU - Maurovich-Horvat, Pal
AU - Ghemigian, Khristine
AU - Ivanov, Alexander
AU - Adami, Elizabeth
AU - Nagurney, John T.
AU - Woodard, Pamela K.
AU - Truong, Quynh A.
AU - Udelson, James E.
AU - Hoffmann, Udo
N1 - Funding Information:
ROMICAT II Support NIH U01HL092040 and U01HL092022, ACRIN.Ferencik: Research Grant/Significant: American Heart Association Fellow to Faculty Award 13FTF16450001.Truong: Research Grant/Significant: NIH/NHLBI K23HL098370 and L30HL093896, St. Jude Medical, American College of Radiology Imaging Network, and Duke Clinical Research.Hoffmann: Research Grant/Significant: NIH U01HL092040, U01HL092022, Siemens Medical Solutions, Heart Flow Inc; Consultant/Advisory Board/Significant: Heart Flow.
Funding Information:
ROMICAT II Support NIH U01HL092040 and U01HL092022, ACRIN.Ferencik: Research Grant/Significant: American Heart Association Fellow to Faculty Award 13FTF16450001.Truong: Research Grant/Significant: NIH/NHLBI K23HL098370 and L30HL093896, St. Jude Medical, American College of Radiology Imaging Network, and Duke Clinical Research.Hoffmann: Research Grant/Significant: NIH U01HL092040, U01HL092022, Siemens Medical Solutions, Heart Flow Inc; Consultant/Advisory Board/Significant: Heart Flow. The authors thank Drs. Campbell Rogers and Souma Sengupta (Heart Flow) for calculation of FFR
Publisher Copyright:
© 2019 Society of Cardiovascular Computed Tomography
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background: Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFRCT in the population of acute chest pain patients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFRCT was measured in a core laboratory. Results: We found correlation between anatomic severity of stenosis and FFRCT ≤0.80 vs. FFRCT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFRCT values (median 0.64, 25th-75th percentile 0.50–0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78–0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFRCT ≤0.80 was 4.03 (95% CI 1.56–10.36) and 3.50 (95% CI 1.12–10.96), respectively. FFRCT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55–9.85, p = 0.004) after adjustment for stenosis severity. Conclusion: Abnormal FFRCT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFRCT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.
AB - Background: Non-invasive fractional flow reserve (FFRCT) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFRCT in the population of acute chest pain patients and assessed the relationship of FFRCT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFRCT was measured in a core laboratory. Results: We found correlation between anatomic severity of stenosis and FFRCT ≤0.80 vs. FFRCT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFRCT values (median 0.64, 25th-75th percentile 0.50–0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78–0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFRCT ≤0.80 was 4.03 (95% CI 1.56–10.36) and 3.50 (95% CI 1.12–10.96), respectively. FFRCT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55–9.85, p = 0.004) after adjustment for stenosis severity. Conclusion: Abnormal FFRCT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFRCT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.
KW - Acute coronary syndrome
KW - Coronary computed tomography angiography
KW - Non-invasive cardiac testing
KW - Non-invasive fractional flow reserve
KW - Risk stratification
KW - Stress test
UR - http://www.scopus.com/inward/record.url?scp=85065768667&partnerID=8YFLogxK
U2 - 10.1016/j.jcct.2019.05.009
DO - 10.1016/j.jcct.2019.05.009
M3 - Article
C2 - 31113728
AN - SCOPUS:85065768667
SN - 1934-5925
VL - 13
SP - 196
EP - 202
JO - Journal of cardiovascular computed tomography
JF - Journal of cardiovascular computed tomography
IS - 4
ER -