Diagnostic performance of quantitative coronary computed tomography angiography and quantitative coronary angiography to predict hemodynamic significance of intermediate-grade stenoses.
Fractional flow reserve (FFR) during invasive coronary angiography has become an established tool for guiding treatment. However, only one-third of intermediate-grade coronary artery stenosis (ICAS) are hemodynamically significant and require coronary revascularization. Additionally, the severity of stenosis visually established by coronary computed tomography angiography (CCTA) does not reliably correlate with the functional severity. Therefore, additional angiographic morphologic descriptors affecting hemodynamic significance are required. To evaluate quantitative stenosis analysis and plaque descriptors by CCTA in predicting the hemodynamic significance of ICAS and to compare it with quantitative catheter coronary angiography (QCA). QCA was performed in 65 patients (mean age 63 ± 9 years; 47 men) with 76 ICAS (40-70%) on CCTA. Plaque descriptors were determined including circumferential extent of calcification, plaque composition, minimal lumen diameter (MLD) and area, diameter stenosis percentage (Ds %), area stenosis percentage and stenosis length on CCTA. MLD and Ds % were also analyzed on QCA. FFR was measured on 52 ICAS lesions on CCTA and QCA. The diagnostic values of the best CCTA and QCA descriptors were calculated for ICAS with FFR ≤ 0.80. Of the 76 ICAS on CCTA, 52 (68%) had a Ds % between 40 and 70% on QCA. Significant intertechnique correlations were found between CCTA and QCA for MLD and Ds % (p < 0.001). In 17 (33%) of the 52 ICAS lesions on QCA, FFR values were ≤ 0.80. Calcification circumference extent (p = 0.50) and plaque composition assessment (p = 0.59) did not correlate with the hemodynamic significance. Best predictors for FFR ≤ 0.80 stenosis were ≤ 1.35 mm MLD (82% sensitivity, 66% specificity), and ≤ 2.3 mm(²) minimal lumen area (88% sensitivity, 60% specificity) on CCTA, and ≤ 1.1 mm MLD (59% sensitivity, 77% specificity) on QCA. Quantitative CCTA and QCA poorly predict hemodynamic significance of ICAS, though CCTA seems to have a better sensitivity than QCA. In this range of stenoses, additional functional evaluation is required.
Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye 75, Liège, 4000, Belgium. olivierghekiere@gmail.com.|Department of Radiology, Jessa Ziekenhuis, Stadsomvaart 11, Hasselt, 3500, Belgium. olivierghekiere@gmail.com.|Faculty of Medecine and Life Sciences, Hasselt University, Martenlarenlaan 42, Hasselt, 3500, Belgium. olivierghekiere@gmail.com.
Olivier
O
Ghekiere
Department of cardiology, Amphia Ziekenhuis, Molengracht 21, 4818 CK, Breda, The Netherlands.
Willem
W
Dewilde
Department of cardiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye 75, Liège, 4000, Belgium.
Michel
M
Bellekens
Department of Radiology, Clinique du Parc, 50 rue Emile Combes, 34170, Castelnau-le-Lez, France.
Denis
D
Hoa
Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye 75, Liège, 4000, Belgium.
Thierry
T
Couvreur
Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye 75, Liège, 4000, Belgium.
Julien
J
Djekic
Department of Radiology, Université Libre de Bruxelles (ULB), Route de Lennik 808, Bruxelles, 1070, Belgium.
Tim
T
Coolen
Department of Radiology, Centre Hospitalier Chrétien (CHC), Rue de Hesbaye 75, Liège, 4000, Belgium.
Isabelle
I
Mancini
Department of Radiology, OLV ziekenhuis Aalst, Moorselbaan 164, Aalst, 9300, Belgium.
Piet K
PK
Vanhoenacker
Faculty of Medecine and Life Sciences, Hasselt University, Martenlarenlaan 42, Hasselt, 3500, Belgium.|Department of Cardiology, Jessa Ziekenhuis, Stadsomvaart 11, Hasselt, 3500, Belgium.
Paul
P
Dendale
Department of Radiology, University Hospital Sart-Tilman Liège (ULg), GIGA cardiovascular diseases, Domaine universitaire du Sart Tilman, Rue de l'hôpital 1, Liège, 4000, Belgium.
Alain
A
Nchimi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000503:physiopathology
Fractional flow reserve (FFR); Hemodynamic significance; Intermediate-grade coronary artery stenosis; Plaque descriptors; Quantitative coronary angiography (QCA); Quantitative coronary computed tomography angiography (CCTA)