Diffuse coronary artery disease among other atherosclerotic plaque characteristics by coronary computed tomography angiography for predicting coronary vessel-specific ischemia by fractional flow reserve.
Coronary computed tomography angiography (CCTA) permits effective identification of diffuse CAD and atherosclerotic plaque characteristics (APCs). We sought to examine the usefulness of diffuse CAD beyond luminal narrowing and APCs by CCTA to detect vessel-specific ischemia.



407 vessels (n = 252 patients) from the DeFACTO diagnostic accuracy study were retrospectively analyzed for percent plaque diffuseness (PD). Percent plaque diffuseness (PD) was obtained on per-vessel level by summation of all contiguous lesion lengths and divided by total vessel length, and was logarithmically transformed (log percent PD). Additional CCTA measures of stenosis severity including minimal lumen diameter (MLD), and APCs, such as positive remodeling (PR) and low attenuation plaque (LAP), were also included. Vessel-specific ischemia was defined as fractional flow reserve (FFR) ≤0.80. Multivariable regression, discrimination by area under the receiver operating characteristic curve (AUC), and category-free net reclassification improvement (cNRI) were assessed.



Backward stepwise logistic regression revealed that for every unit increase in log percent PD, there was a 58% (95% CI: 1.01-2.48, p = 0.048) rise in the odds of having an abnormal FFR, independent of stenosis severity and APCs. The AUC indicated no further improvement in discriminatory ability after adding log percent PD to the final parsimonious model of MLD, PR, and LAP (AUC difference: 0.003, 95% CI: -0.003-0.010, p = 0.33). Conversely, adding log percent PD to the base model of MLD, PR, and LAP improved cNRI by 0.21 (95% CI: 0.01-0.41, p < 0.001).



Accounting for diffuse CAD may help improve the accuracy of CCTA for detecting vessel-specific ischemia.
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Asim
A
Rizvi
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Bríain Ó
BÓ
Hartaigh
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Ibrahim
I
Danad
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Donghee
D
Han
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Ji Hyun
JH
Lee
Departments of Imaging and Medicine, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
Heidi
H
Gransar
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States.
Jackie
J
Szymonifka
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States; Departments of Radiology and Medicine, Weill Cornell Medicine, New York, NY, United States.
Fay Y
FY
Lin
Dalio Institute of Cardiovascular Imaging, Department of Radiology, NewYork-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, United States; Departments of Radiology and Medicine, Weill Cornell Medicine, New York, NY, United States. Electronic address: jkm2001@med.cornell.edu.
James K
JK
Min
D000368:Aged; D019540:Area Under Curve; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D005060:Europe; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D009656:North America; D015588:Observer Variation; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index
Atherosclerotic plaque characteristics; Coronary computed tomography angiography; Diffuse coronary artery disease; Fractional flow reserve; Stenosis severity