Department of Radiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, China.
Catheterization Laboratories, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Road, Xicheng District, Beijing, 100037, China.
Eur J Radiol. 2021 May;138:109634. doi: 10.1016/j.ejrad.2021.109634. Epub 2021 Mar 8.
To evaluate the diagnostic performance of fractional flow reserve (FFR) derived from coronary computed tomography angiography (CCTA; CT-FFR) and combined plaque characteristics for ischemia in different CCTA stenosis levels.
This clinical trial analyzed 317 patients with 30 %-90 % coronary stenosis in 366 vessels from 5 centers undergoing CCTA and invasive FFR. 366 vessels were assigned into < 50 % (nonobstructive) and ≥ 50 % (obstructive) stenosis groups. Lesion length (LL), plaque burden (PB), diameter stenosis (DS), volume ratio of plaque subcomponents < 30 HU (VR < 30HU), and high-risk features were analyzed. Logistic regression models were used to identify plaque characteristic predictors for lesion-specific ischemia in different stenosis grades. The area under receiver operating characteristics curve (AUC) of integrated plaque characteristics and CT-FFR were calculated and compared.
In < 50 % stenosis lesions, PB (OR: 1.296, p = 0.002), LL (OR:1.075, p = 0.020), and DS (OR:1.085, p = 0.031) were independent predictors of ischemia. In ≥ 50 % stenosis lesions, VR < 30HU (OR:1.031, p = 0.005) and DS (OR: 1.020, p = 0.044) were independent predictors for ischemia. AUC of plaque characteristic (VR < 30HU plus DS) for ischemia was 0.67 (95 % CI: 0.61-0.72) in ≥ 50 % stenosis level, which was significantly lower than CT-FFR (AUC=0.90; 95 % CI: 0.86-0.93) (p < 0.001). For lesions causing < 50 % stenosis, AUC of combined plaque model (VR < 30HU plus DS) was 0.88 (95 % CI: 0.80-0.95), equivalent to AUC of CT-FFR (AUC = 0.88; 95 % CI: 0.80-0.96; p = 0.957).
CT-FFR is a powerful functional assessment tool for both obstructive and nonobstructive diseases. However, for nonobstructive CAD confirmed by CCTA, a model of a combination of plaque characteristics could be a valuable alternative to CT-FFR.
评估基于冠状动脉计算机断层血管造影术（CCTA；CT-FFR）的分流量储备（FFR）和斑块特征综合分析对不同 CCTA 狭窄程度下缺血的诊断性能。
本临床试验分析了 5 个中心的 317 例 366 支血管中狭窄程度在 30%-90%之间的患者的 CCTA 和有创 FFR。将 366 支血管分为<50%（非阻塞性）和≥50%（阻塞性）狭窄组。分析病变长度（LL）、斑块负荷（PB）、直径狭窄（DS）、斑块亚成分<30HU 的体积比（VR<30HU）和高危特征。采用 logistic 回归模型确定不同狭窄程度下斑块特征对特定病变缺血的预测因子。计算并比较整合斑块特征和 CT-FFR 的受试者工作特征曲线（ROC）下面积（AUC）。
在<50%狭窄病变中，PB（OR：1.296，p=0.002）、LL（OR：1.075，p=0.020）和 DS（OR：1.085，p=0.031）是缺血的独立预测因子。在≥50%狭窄病变中，VR<30HU（OR：1.031，p=0.005）和 DS（OR：1.020，p=0.044）是缺血的独立预测因子。VR<30HU 和 DS 的斑块特征（VR<30HU 加 DS）对缺血的 AUC 在≥50%狭窄水平为 0.67（95%CI：0.61-0.72），明显低于 CT-FFR（AUC=0.90；95%CI：0.86-0.93）（p<0.001）。对于导致<50%狭窄的病变，联合斑块模型（VR<30HU 加 DS）的 AUC 为 0.88（95%CI：0.80-0.95），与 CT-FFR 的 AUC 相等（AUC=0.88；95%CI：0.80-0.96；p=0.957）。
CT-FFR 是一种强大的功能性评估工具，适用于阻塞性和非阻塞性疾病。然而，对于 CCTA 证实的非阻塞性 CAD，斑块特征的组合模型可能是 CT-FFR 的一种有价值的替代方法。
