Additive diagnostic value of atherosclerotic plaque characteristics to non-invasive FFR for identification of lesions causing ischaemia: results from a prospective international multicentre trial.
OBJECTIVE
We evaluated the association between atherosclerotic plaque characteristics (APCs) by CT -including positive remodelling (PR), low attenuation plaque (LAP) and spotty calcification (SC)- and lesion ischaemia by fractional flow reserve (FFR).


RESULTS
Two hundred and fifty-two patients (17 centres, five countries) underwent CT, FFR derived from CT (FFRCT) with invasive FFR performed for 407 coronary lesions. FFR ≤0.8 was indicative of lesion-specific ischaemia. CT diameter ≥50% stenosis was considered obstructive. APCs by CT were defined as: (1) PR, lesion diameter/reference diameter >1.10; (2) LAP, any voxel <30 HU; and (3) SC, nodular calcified plaque <3 mm. Odds ratios (OR) and area under the ROC curve (AUC) of APCs for lesion-specific ischaemia were analysed. PR, LAP and SC were associated with ischaemia, with a three to fivefold higher prevalence than in non-ischaemic lesions. Among individual APC, PR (OR 4.7, p<0.001), but not SC or LAP, was strongly associated with lesion-specific ischaemia and provided incremental prediction for lesion-specific ischaemia over CT stenosis plus FFRCT (AUC 0.87 vs. 0.83, p=0.002).


CONCLUSIONS
APCs' features -especially PR- by CT improve identification and reclassification of coronary lesions which cause ischaemia over CT stenosis and FFRCT.
Cardiovascular Center, St. Luke's International Hospital, Tokyo, Japan.
Ryo
R
Nakazato
Hyung-Bok
HB
Park
Heidi
H
Gransar
Jonathon A
JA
Leipsic
Matthew J
MJ
Budoff
G B John
GB
Mancini
Andrejs
A
Erglis
Daniel S
DS
Berman
James K
JK
Min
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D023921:Coronary Stenosis / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D007511:Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000150:complications