title: Advanced computed tomographic anatomical and morphometric plaque analysis for prediction of fractional flow reserve in intermediate coronary lesions.
abstract: OBJECTIVE
  To determine the application of advanced coronary computed tomography angiography (CCTA) plaque analysis for predicting invasive fractional flow reserve (FFR) in intermediate coronary lesions.
  
  
  METHODS
  Sixty-one patients with 71 single intermediate coronary lesions (≥ 50-80% stenosis) on CCTA prospectively underwent coronary angiography and FFR. Advanced anatomical and morphometric plaque analysis was performed based on CCTA data set to determine optimal criteria for significant flow impairment. A significant stenosis was defined as FFR ≤ 0.80.
  
  
  RESULTS
  FFR averaged 0.85 ± 0.09, and 19 lesions (27%) were functionally significant. FFR correlated with minimum lumen area (MLA) (r=0.456, p<0.001), minimum lumen diameter (MLD) (r=0.326, p=0.006), reference lumen diameter (RLD) (r=0.245, p=0.039), plaque burden (r=-0.313, p=0.008), lumen area stenosis (r=-0.305, p=0.01), lesion length (r=-0.692, p<0.001), and plaque volume (r=-0.668, p<0.001). There was no relationship between FFR and CCTA morphometric plaque parameters. By multivariate analysis the independent predictors of FFR were lesion length (beta=-0.581, p<0.001), MLA (beta=0.360, p=0.041), and RLD (beta=-0.255, p=0.036). The optimal cutoffs for lesion length, MLA, MLD, RLD, and lumen area stenosis were >18.5mm, ≤ 3.0mm(2), ≤ 2.1mm, ≤ 3.2mm, and >69%, respectively (max. sensitivity: 100% for MLA, max. specificity: 79% for lumen area stenosis).
  
  
  CONCLUSIONS
  CCTA predictors for FFR support the mathematical relationship between stenosis pressure drop and coronary flow. CCTA could prove to be a useful rule-out test for significant hemodynamic effects of intermediate coronary stenoses.
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: opolski.mp@gmail.com.
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: c.kepka@ikard.pl.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
authors.affiliation: Department of Internal Medicine 2 (Cardiology), University of Erlangen, Erlangen, Germany. Electronic address: stephan.achenbach@uk-erlangen.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Achenbach
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: jerzypregowski74@gmail.com.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pregowski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: mariuszkruk2000@yahoo.com.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.affiliation: Medical University of Warsaw, Warsaw, Poland. Electronic address: adstarman@gmail.com.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Staruch
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: j.kadziela@ikard.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kadziela
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland. Electronic address: w.ruzyllo@ikard.pl.
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: witkowski@hbz.pl.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011856:Radiographic Image Enhancement / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Coronary computed tomography angiography; Fractional flow reserve; Intermediate coronary stenosis