Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve

Hyung Bok Park; Ran Heo; Bríain Ó Hartaigh; Iksung Cho; Heidi Gransar; Ro Nakazato; Jonathon Leipsic; G. B.John Mancini; Bon Kwon Koo; Hiromasa Otake; Matthew J. Budoff; Daniel S. Berman; Andrejs Erglis; Hyuk Jae Chang; James K. Min

doi:10.1016/j.jcmg.2014.11.002

Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve

Hyung Bok Park, Ran Heo, Bríain Ó Hartaigh, Iksung Cho, Heidi Gransar, Ro Nakazato, Jonathon Leipsic, G. B.John Mancini, Bon Kwon Koo, Hiromasa Otake, Matthew J. Budoff, Daniel S. Berman, Andrejs Erglis, Hyuk Jae Chang, James K. Min

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

221 Citations (Scopus)

Abstract

OBJECTIVES This study evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary computed tomographic angiography (CTA), and lesion ischemia by fractional flow reserve (FFR). BACKGROUND FFR is the gold standard for determining lesion ischemia. Although APCs by CTA-including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP), and spotty calcification (SC)-are associated with future coronary syndromes, their relationship to lesion ischemia is unclear. METHODS 252 patients (17 centers, 5 countries; mean age 63 years; 71% males) underwent coronary CTA, with FFR performed for 407 coronary lesions. Coronary CTA was interpreted for <50% and ≥50% stenosis, with the latter considered obstructive. APCs by coronary CTA were defined as: 1) PR, lesion diameter/reference diameter <1.10; 2) LAP, any voxel <30 Hounsfield units; and 3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and net reclassification improvement of APCs for lesion ischemia, defined by FFR ≥0.8, were analyzed. RESULTS By FFR, ischemia was present in 151 lesions (37%). %APV was associated with a 50% increased risk of ischemia per 5% additional APV. PR, LAP, and SC were associated with ischemia, with a 3 to 5 times higher prevalence than in nonischemic lesions. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 (OR: 4.0, p < 0.001) and ≥2 (OR: 12.1, p < 0.001) APCs. These findings were APC dependent, with PR (OR: 5.3, p < 0.001) and LAP (OR: 2.1, p = 0.038) associated with ischemia, but not SC. When examined by stenosis severity, PR remained a predictor of ischemia for all lesions, whereas %APV and LAP were associated with ischemia for only ≥50%, but not for <50%, stenosis. CONCLUSIONS %APV and APCs by coronary CTA improve identification of coronary lesions that cause ischemia. PR is associated with all ischemia-causing lesions, whereas %APV and LAP are only associated with ischemia-causing lesions ≥50%. (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography; NCT01233518).

Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	JACC: Cardiovascular Imaging
Volume	8
Issue number	1
DOIs	https://doi.org/10.1016/j.jcmg.2014.11.002
Publication status	Published - 2015

Bibliographical note

Funding Information:
This work was supported by the ICT R&D program of MSIP/IITP [10044910, Development of Multi-modality Imaging and 3D Simulation-Based Integrative Diagnosis-Treatment Support Software System for Cardiovascular Diseases] and the National Institutes of Health (R01HL115150 and R01HL118019). Dr. Leipsic is a consultant for HeartFlow; and serves on the medical advisory board for GE Healthcare. Dr. Budoff serves on the medical advisory board for GE Healthcare. Dr. Min serves as a consultant to HeartFlow, and Abbott Vascular; is on the medical advisory board for GE Healthcare and Arineta; and holds ownership in MDDX. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Paul Schoenhagen, MD, served as Guest Editor for this paper.

Publisher Copyright:
© 2015 by the American College of Cardiology Foundation.

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.jcmg.2014.11.002

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Park, H. B., Heo, R., Ó Hartaigh, B., Cho, I., Gransar, H., Nakazato, R., Leipsic, J., Mancini, G. B. J., Koo, B. K., Otake, H., Budoff, M. J., Berman, D. S., Erglis, A., Chang, H. J., & Min, J. K. (2015). Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve. JACC: Cardiovascular Imaging, 8(1), 1-10. https://doi.org/10.1016/j.jcmg.2014.11.002

@article{261f0e1420c345a79e6ebaf9750d7ab5,

title = "Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve",

abstract = "OBJECTIVES This study evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary computed tomographic angiography (CTA), and lesion ischemia by fractional flow reserve (FFR). BACKGROUND FFR is the gold standard for determining lesion ischemia. Although APCs by CTA-including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP), and spotty calcification (SC)-are associated with future coronary syndromes, their relationship to lesion ischemia is unclear. METHODS 252 patients (17 centers, 5 countries; mean age 63 years; 71% males) underwent coronary CTA, with FFR performed for 407 coronary lesions. Coronary CTA was interpreted for <50% and ≥50% stenosis, with the latter considered obstructive. APCs by coronary CTA were defined as: 1) PR, lesion diameter/reference diameter <1.10; 2) LAP, any voxel <30 Hounsfield units; and 3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and net reclassification improvement of APCs for lesion ischemia, defined by FFR ≥0.8, were analyzed. RESULTS By FFR, ischemia was present in 151 lesions (37%). %APV was associated with a 50% increased risk of ischemia per 5% additional APV. PR, LAP, and SC were associated with ischemia, with a 3 to 5 times higher prevalence than in nonischemic lesions. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 (OR: 4.0, p < 0.001) and ≥2 (OR: 12.1, p < 0.001) APCs. These findings were APC dependent, with PR (OR: 5.3, p < 0.001) and LAP (OR: 2.1, p = 0.038) associated with ischemia, but not SC. When examined by stenosis severity, PR remained a predictor of ischemia for all lesions, whereas %APV and LAP were associated with ischemia for only ≥50%, but not for <50%, stenosis. CONCLUSIONS %APV and APCs by coronary CTA improve identification of coronary lesions that cause ischemia. PR is associated with all ischemia-causing lesions, whereas %APV and LAP are only associated with ischemia-causing lesions ≥50%. (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography; NCT01233518).",

author = "Park, {Hyung Bok} and Ran Heo and {{\'O} Hartaigh}, Br{\'i}ain and Iksung Cho and Heidi Gransar and Ro Nakazato and Jonathon Leipsic and Mancini, {G. B.John} and Koo, {Bon Kwon} and Hiromasa Otake and Budoff, {Matthew J.} and Berman, {Daniel S.} and Andrejs Erglis and Chang, {Hyuk Jae} and Min, {James K.}",

note = "Funding Information: This work was supported by the ICT R&D program of MSIP/IITP [10044910, Development of Multi-modality Imaging and 3D Simulation-Based Integrative Diagnosis-Treatment Support Software System for Cardiovascular Diseases] and the National Institutes of Health (R01HL115150 and R01HL118019). Dr. Leipsic is a consultant for HeartFlow; and serves on the medical advisory board for GE Healthcare. Dr. Budoff serves on the medical advisory board for GE Healthcare. Dr. Min serves as a consultant to HeartFlow, and Abbott Vascular; is on the medical advisory board for GE Healthcare and Arineta; and holds ownership in MDDX. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Paul Schoenhagen, MD, served as Guest Editor for this paper. Publisher Copyright: {\textcopyright} 2015 by the American College of Cardiology Foundation.",

year = "2015",

doi = "10.1016/j.jcmg.2014.11.002",

language = "English",

volume = "8",

pages = "1--10",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "1",

}

Park, HB, Heo, R, Ó Hartaigh, B, Cho, I, Gransar, H, Nakazato, R, Leipsic, J, Mancini, GBJ, Koo, BK, Otake, H, Budoff, MJ, Berman, DS, Erglis, A, Chang, HJ & Min, JK 2015, 'Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve', JACC: Cardiovascular Imaging, vol. 8, no. 1, pp. 1-10. https://doi.org/10.1016/j.jcmg.2014.11.002

TY - JOUR

T1 - Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia

T2 - A direct comparison to fractional flow reserve

AU - Park, Hyung Bok

AU - Heo, Ran

AU - Ó Hartaigh, Bríain

AU - Cho, Iksung

AU - Gransar, Heidi

AU - Nakazato, Ro

AU - Leipsic, Jonathon

AU - Mancini, G. B.John

AU - Koo, Bon Kwon

AU - Otake, Hiromasa

AU - Budoff, Matthew J.

AU - Berman, Daniel S.

AU - Erglis, Andrejs

AU - Chang, Hyuk Jae

AU - Min, James K.

N1 - Funding Information: This work was supported by the ICT R&D program of MSIP/IITP [10044910, Development of Multi-modality Imaging and 3D Simulation-Based Integrative Diagnosis-Treatment Support Software System for Cardiovascular Diseases] and the National Institutes of Health (R01HL115150 and R01HL118019). Dr. Leipsic is a consultant for HeartFlow; and serves on the medical advisory board for GE Healthcare. Dr. Budoff serves on the medical advisory board for GE Healthcare. Dr. Min serves as a consultant to HeartFlow, and Abbott Vascular; is on the medical advisory board for GE Healthcare and Arineta; and holds ownership in MDDX. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Paul Schoenhagen, MD, served as Guest Editor for this paper. Publisher Copyright: © 2015 by the American College of Cardiology Foundation.

PY - 2015

Y1 - 2015

N2 - OBJECTIVES This study evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary computed tomographic angiography (CTA), and lesion ischemia by fractional flow reserve (FFR). BACKGROUND FFR is the gold standard for determining lesion ischemia. Although APCs by CTA-including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP), and spotty calcification (SC)-are associated with future coronary syndromes, their relationship to lesion ischemia is unclear. METHODS 252 patients (17 centers, 5 countries; mean age 63 years; 71% males) underwent coronary CTA, with FFR performed for 407 coronary lesions. Coronary CTA was interpreted for <50% and ≥50% stenosis, with the latter considered obstructive. APCs by coronary CTA were defined as: 1) PR, lesion diameter/reference diameter <1.10; 2) LAP, any voxel <30 Hounsfield units; and 3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and net reclassification improvement of APCs for lesion ischemia, defined by FFR ≥0.8, were analyzed. RESULTS By FFR, ischemia was present in 151 lesions (37%). %APV was associated with a 50% increased risk of ischemia per 5% additional APV. PR, LAP, and SC were associated with ischemia, with a 3 to 5 times higher prevalence than in nonischemic lesions. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 (OR: 4.0, p < 0.001) and ≥2 (OR: 12.1, p < 0.001) APCs. These findings were APC dependent, with PR (OR: 5.3, p < 0.001) and LAP (OR: 2.1, p = 0.038) associated with ischemia, but not SC. When examined by stenosis severity, PR remained a predictor of ischemia for all lesions, whereas %APV and LAP were associated with ischemia for only ≥50%, but not for <50%, stenosis. CONCLUSIONS %APV and APCs by coronary CTA improve identification of coronary lesions that cause ischemia. PR is associated with all ischemia-causing lesions, whereas %APV and LAP are only associated with ischemia-causing lesions ≥50%. (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography; NCT01233518).

AB - OBJECTIVES This study evaluated the association between atherosclerotic plaque characteristics (APCs) by coronary computed tomographic angiography (CTA), and lesion ischemia by fractional flow reserve (FFR). BACKGROUND FFR is the gold standard for determining lesion ischemia. Although APCs by CTA-including aggregate plaque volume % (%APV), positive remodeling (PR), low attenuation plaque (LAP), and spotty calcification (SC)-are associated with future coronary syndromes, their relationship to lesion ischemia is unclear. METHODS 252 patients (17 centers, 5 countries; mean age 63 years; 71% males) underwent coronary CTA, with FFR performed for 407 coronary lesions. Coronary CTA was interpreted for <50% and ≥50% stenosis, with the latter considered obstructive. APCs by coronary CTA were defined as: 1) PR, lesion diameter/reference diameter <1.10; 2) LAP, any voxel <30 Hounsfield units; and 3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and net reclassification improvement of APCs for lesion ischemia, defined by FFR ≥0.8, were analyzed. RESULTS By FFR, ischemia was present in 151 lesions (37%). %APV was associated with a 50% increased risk of ischemia per 5% additional APV. PR, LAP, and SC were associated with ischemia, with a 3 to 5 times higher prevalence than in nonischemic lesions. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 (OR: 4.0, p < 0.001) and ≥2 (OR: 12.1, p < 0.001) APCs. These findings were APC dependent, with PR (OR: 5.3, p < 0.001) and LAP (OR: 2.1, p = 0.038) associated with ischemia, but not SC. When examined by stenosis severity, PR remained a predictor of ischemia for all lesions, whereas %APV and LAP were associated with ischemia for only ≥50%, but not for <50%, stenosis. CONCLUSIONS %APV and APCs by coronary CTA improve identification of coronary lesions that cause ischemia. PR is associated with all ischemia-causing lesions, whereas %APV and LAP are only associated with ischemia-causing lesions ≥50%. (Determination of Fractional Flow Reserve by Anatomic Computed Tomographic Angiography; NCT01233518).

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Atherosclerotic plaque characteristics by CT angiography identify coronary lesions that cause ischemia: A direct comparison to fractional flow reserve

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