Cardiac computed tomography-derived coronary artery volume to myocardial mass

Ihdayhid, Abdul Rahman; Fairbairn, Timothy; Gulsin, Gaurav S; Τζίμας, Γεώργιος; Danehy, Edward; Updegrove, Adam; Jensen, Jesper Møller; Taylor, Charles A.; Bax, Jeroen J.; Sellers, Stephanie; Leipsic, Jonathon; Nørgaard, Bjarne Linde

doi:10.1016/j.jcct.2021.10.007

Cited by 21 publications

(13 citation statements)

References 71 publications

(88 reference statements)

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“…The repeated CTA + FFR CT investigation strategy in the FLOWPROMOTE study allows for comprehensive assessment of the temporal interplay between lipid lowering therapy, changes in disease morphology and physiology including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score. 25 , 30 , 31 …”

Section: Discussionmentioning

confidence: 99%

“…Thus, relative to traditional FFR CT metrics, FFR CT ‐AUC may add important information on the impact of lipid lowering therapy on flow both in vessels with or without FFR CT ≤ 0.80 at baseline. The repeated CTA + FFR CT investigation strategy in the FLOWPROMOTE study allows for comprehensive assessment of the temporal interplay between lipid lowering therapy, changes in disease morphology and physiology including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score 25,30,31 …”

Section: Discussionmentioning

confidence: 99%

“…Given the many beneficial changes in plaque phenotype characteristics that are observed with lipid lowering therapies, including reduction in LAP volumes [15][16][17][18][38][39][40] and recent data demonstrating that such features are independent predictors of lesion-specific ischemia expressed by abnormal FFR including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score. 25,30,31 In the FLOWPROMOTE study, patients are randomized to two with previous studies demonstrating that the extent of plaque volume regression is greater in patients who achieve the lowest LDL cholesterol values. 38,39 Importantly, these previous studies have not indicated that there is a lower LDL threshold beyond which further LDL lowering would not yield additional plaque regression.…”

Section: Discussionmentioning

confidence: 99%

“…Lesions and segments of interests will be identified on a blank 3‐dimensional computer model, followed by blinded integration of the relevant FFR CT values ensuring comparison of corresponding FFR CT data. For sub‐study analysis the coronary volume‐to‐myocardial mass (V/M) and the ischemic myocardial burden as assessed by the APPROACH FFRCT score will be calculated 30,31 …”

Section: Methodsmentioning

confidence: 99%

“…For sub-study analysis the coronary volume-to-myocardial mass (V/M) and the ischemic myocardial burden as assessed by the APPROACH FFRCT score will be calculated. 30,31 2.9 | Randomization and treatment…”

Section: Cta Derived Fractional Flow Reservementioning

confidence: 99%

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Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Mortensen

Sand²,

Busk

et al. 2022

Clinical Cardiology

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Introduction Coronary CT angiography (CTA) derived fractional flow reserve (FFR CT ) shows high diagnostic performance when compared to invasively measured FFR. Presence and extent of low attenuation plaque density have been shown to be associated with abnormal physiology by measured FFR. Moreover, it is well established that statin therapy reduces the rate of plaque progression and results in morphology alterations underlying atherosclerosis. However, the interplay between lipid lowering treatment, plaque regression, and the coronary physiology has not previously been investigated. Aim To test whether lipid lowering therapy is associated with significant improvement in FFR CT , and whether there is a dose–response relationship between lipid lowering intensity, plaque regression, and coronary flow recovery. Methods Investigator driven, prospective, multicenter, randomized study of patients with stable angina, coronary stenosis ≥50% determined by clinically indicated first‐line CTA, and FFR CT ≤ 0.80 in whom coronary revascularization was deferred. Patients are randomized to standard (atorvastatin 40 mg daily) or intensive (rosuvastatin 40 mg + ezetimibe 10 mg daily) lipid lowering therapy for 18 months. Coronary CTA scans with blinded coronary plaque and FFR CT analyses will be repeated after 9 and 18 months. The primary endpoint is the 18‐month difference in FFR CT using (1) the FFR CT value 2 cm distal to stenosis and (2) the lowest distal value in the vessel of interest. A total of 104 patients will be included in the study. Conclusion The results of this study will provide novel insights into the interplay between lipid lowering, and the pathophysiology in coronary artery disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Cta Derived Fractional Flow Reservementioning

confidence: 99%

See 3 more Smart Citations

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Mortensen

Sand²,

Busk

et al. 2022

Clinical Cardiology

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Temporal changes in CT-derived fractional flow reserve in patients after heart transplantation

Sharma,

Sanz,

Hirsch

et al. 2024

Eur Radiol

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Background Adding functional information by CT-derived fractional flow reserve (FFRct) to coronary CT angiography (CCTA) and assessing its temporal change may provide insight into the natural history and physiopathology of cardiac allograft vasculopathy (CAV) in heart transplantation (HTx) patients. We assessed FFRct changes as well as CAV progression over a 2-year period in HTx patients undergoing serial CT imaging. Methods HTx patients from Erasmus MC and Mount Sinai Hospital, who had consecutive CCTAs 2 years apart were evaluated. FFRct analysis was performed for both scans. FFRct values at the most distal point in the left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) were measured after precisely matching the anatomical locations in both analyses. Also, the number of anatomical coronary stenoses of > 30% was scored. Results In total, 106 patients (median age 57 [interquartile range 47–67] years, 67% male) at 9 [6–13] years after HTx at the time of the baseline CCTA were included. Median distal FFRct values significantly decreased from baseline to follow-up for the LAD from 0.85 [0.79–0.90] to 0.84 [0.76–0.90] (p = 0.001), LCX from 0.92 [0.88–0.96] to 0.91 [0.85–0.95] (p = 0.009), and RCA from 0.92 [0.86–0.95] to 0.90 [0.86–0.94] (p = 0.004). The number of focal anatomical stenoses of > 30% increased from a median of 1 [0–2] at baseline to 2 [0–3] at follow-up (p = 0.009). Conclusions The distal coronary FFRct values in post-HTX patients in each of the three major coronary arteries decreased, and the number of focal coronary stenoses increased over a 2-year period. Temporal FFRct change rate may become an additional parameter in the follow-up of HTx patients, but more research is needed to elucidate its role. Clinical relevance statement CT-derived fractional flow reserve (FFRct) is important post-heart transplant because of additional information on coronary CT angiography for cardiac allograft vasculopathy (CAV) detection. The decrease and degree of reduction in distal FFRct value may indicate progression in anatomic CAV burden. Key Points CT-derived fractional flow reserve (FFRct) is important for monitoring cardiac allograft vasculopathy (CAV) in heart transplant patients. Over time, transplant patients showed a decrease in distal FFRct and an increase in coronary stenoses. Temporal changes in FFRct could be crucial for transplant follow-up, aiding in CAV detection.

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CCTA-based CABG SYNTAX Score: a tool to evaluate completeness of coronary segment revascularization after bypass surgery

Kotoku,

Serruys,

Kageyama

et al. 2023

Int J Cardiovasc Imaging

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To describe the updated coronary computed tomographic angiography (CCTA)-based coronary artery bypass graft (CABG) anatomic SYNTAX Score (aSS) and assess its utility and reproducibility for assessing the completeness of revascularization after CABG. The CCTA-CABG aSS is a visual assessment using CCTA post-CABG which quantifies the failure in effectively grafting stenotic coronary segments, and therefore assesses the completeness of surgical revascularization. It is calculated by subtracting the aSS of successfully anastomosed coronary segments from the aSS of the native coronary tree. The inter-observer reproducibility of the CCTA-CABG aSS was evaluated in 45 consecutive patients with three-vessel disease with or without left main disease who underwent a CCTA 30 days (± 7 days) after CABG. The CCTA-CABG aSS was evaluated in 45 consecutive patients with 117 bypass grafts and 152 anastomoses. The median native coronary aSS was 35.0 [interquartile range (IQR) 27.0–41.0], whilst the median CCTA-CABG aSS was 13.0 (IQR 9.0–20.5). The inter-observer level of agreement for the native coronary aSS and the CCTA-CABG aSS were both substantial with respective Kappas of 0.67 and 0.61. The CCTA-CABG aSS was feasible in all patients who underwent CABG for complex coronary artery disease with substantial inter-observer reproducibility, and therefore can be used to quantify the completeness of revascularization after CABG.

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Cardiac computed tomography-derived coronary artery volume to myocardial mass

Cited by 21 publications

References 71 publications

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Temporal changes in CT-derived fractional flow reserve in patients after heart transplantation

CCTA-based CABG SYNTAX Score: a tool to evaluate completeness of coronary segment revascularization after bypass surgery

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