Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease

Tsugu, Toshimitsu; Tanaka, Kaoru; Belsack, Dries; Devos, Hannes; Nagatomo, Yuji; Michiels, Vincent; Argacha, Jean-François; Cosyns, Bernard; Buls, Nico; Maeseneer, Michel De; Mey, Johan De

doi:10.1016/j.ijcard.2021.08.036

Cited by 9 publications

(15 citation statements)

References 30 publications

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“…The finding in our work that vessel morphology was the most important factor influencing FFR CT decline was in line with previous studies [ 3 ]. However, we showed that the bifurcation angle also had a considerable influence on FFR CT decline in vessels with no apparent CAD.…”

Section: Discussionsupporting

confidence: 94%

“…FFR CT is a reliable method for detecting functional ischemia, but it can be difficult to interpret because it is affected by a variety of factors such as vessel length [ 1 ], plaque characteristics [ 2 , 3 ], left ventricular mass [ 4 , 5 ], ramus artery [ 6 ], or collateral circulation [ 7 ]. The left coronary artery bifurcation angle has been shown to affect wall shear stress and cause modifications to the bloodstream [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

et al. 2022

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Objectives Computed tomography (CT) derived fractional flow reserve (FFRCT) decreases from the proximal to the distal part due to a variety of factors. The energy loss due to the bifurcation angle may potentially contribute to a progressive decline in FFRCT. However, the association of the bifurcation angle with FFRCT is still not entirely understood. This study aimed to investigate the impact of various bifurcation angles on FFRCT decline below the clinically crucial relevance of 0.80 in vessels with no apparent coronary artery disease (CAD). Methods A total of 83 patients who underwent both CT angiography including FFRCT and invasive coronary angiography, exhibiting no apparent CAD were evaluated. ΔFFRCT was defined as the change in FFRCT from the proximal to the distal in the left anterior descending artery (LAD) and left circumflex artery (LCX). The bifurcation angle was calculated from three-dimensional volume rendered images. Vessel morphology and plaque characteristics were also assessed. Results ΔFFRCT significantly correlated with the bifurcation angle (LAD angle, r = 0.35, p = 0.001; LCX angle, r = 0.26, p = 0.02) and vessel length (LAD angle, r = 0.30, p = 0.005; LCX angle, r = 0.49, p < 0.0001). In LAD, vessel length was the strongest predictor for distal FFRCT of ≤ 0.80 (β-coefficient = 0.55, p = 0.0003), immediately followed by the bifurcation angle (β-coefficient = 0.24, p = 0.02). The bifurcation angle was a good predictor for a distal FFRCT ≤ 0.80 (LAD angle, cut-off 31.0°, AUC 0.70, sensitivity 74%, specificity 68%; LCX angle, cut-off 52.6°, AUC 0.86, sensitivity 88%, specificity 85%). Conclusions In vessels with no apparent CAD, vessel length was the most influential factor on FFRCT, directly followed by the bifurcation angle. Key Points • Both LAD and LCX bifurcation angles are factors influencing FFRCT. • Bifurcation angle is one of the predictors of a distal FFRCTof ≤ 0.80 and an optimal cut-off value of 31.0° for the LAD and 52.6° for the LCX. • Bifurcation angle should be taken into consideration when interpreting numerical values of FFRCT.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

et al. 2022

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“…Our recent study has shown that the presence of plaque could attribute to FFR CT decline. 9 Therefore, FFR CT interpretation in patients with the ramus artery may require an additional consideration depending on the degree of plaque formation.…”

Section: Discussionmentioning

confidence: 99%

“…Since FFR CT has been shown to be highly correlated with invasive FFR value, 1,5,6 FFR CT assessment may have a potential as a guide for appropriate coronary stenosis revascularization. However, FFR CT interpretation may be difficult, because it is influenced by a variety of factors such as vessel length, 7 plaque volume, 8,9 left ventricular mass, 10 and collateral circulation 11 . Previous studies showed that a wider bifurcation angle yields high turbulence and low shear stress, which induces larger energy loss, resulting in FFR CT decline 12–14 .…”

Section: Introductionmentioning

confidence: 99%

Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFR_CT) in no apparent coronary artery disease

et al. 2023

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Background The ramus artery contributes to the development of turbulence, which may influence computed tomography (CT) derived fractional flow reserve (FFRCT) even without coronary artery disease (CAD). The relationship between ramus‐induced turbulence and FFRCT is unclear. Method and Results A total of 120 patients with <20% coronary stenosis assessed by both FFRCT and invasive coronary angiography were evaluated. The patients were divided into three groups: absent‐ramus (n = 72), small‐ramus that could not be analyzed by FFRCT (n = 18), and large‐ramus that could be analyzed by FFRCT (n = 30). FFRCT measurements were performed at the proximal and distal segments of the left anterior descending (LAD), left circumflex (LCX), and ramus artery. With absent‐ramus and small‐absent ramus groups, FFRCT was measured at the distal end of the left main trunk at the same level for the proximal segments of the LAD and LCX. In absent‐ramus group, proximal FFRCT showed no significant differences between three vessels (LAD = .96 ± .02; MID = .97 ± .02; LCX = .97 ± .02). However, in small and large‐ramus groups, proximal FFRCT was significantly higher in the ramus artery than LAD and LCX (small‐ramus, LAD = .95 ± .03, Ramus = .97 ± .02, LCX = .95 ± .03; large‐ramus: LAD = .95 ± .03, Ramus = .98 ± .01; LCX = .96 ± .03; p < .05). A large ramus was associated with a higher prevalence of a distal FFRCT ≤.80 (odds ratio 7.0, 95% CI 1.2–40.1, p = .03). A proximal ramus diameter predicted distal FFRCT ≤.80 (cut‐off 2.1 mm, AUC .76, sensitivity 100%, specificity 52%, 95% CI .61–.90). Conclusions The presence of a large‐ramus artery may cause an FFRCT decline in no apparent CAD.

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“…The implementation of FFR CT can change treatment strategies and improve diagnostic efficiency and effectiveness in patients with coronary artery disease (CAD) [ 2 ]. Even in non-obstructive CAD (NOCAD), FFR CT gradually decreases from the proximal to the distal segments of the vessel (physiological FFR CT decline) [ 3 , 4 ]. FFR CT is influenced by various factors such as vessel length [ 3 , 4 ], bifurcation angle [ 5 , 6 ], plaque burden [ 3 ], left ventricular mass [ 7 ], and collateral circulation [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of vessel morphology on CT-derived fractional-flow-reserve in non-obstructive coronary artery disease in right coronary artery

Tsugu,

Tanaka,

Belsack

et al. 2023

Eur Radiol

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Objectives Computed tomography (CT)–derived fractional flow reserve (FFRCT) decreases continuously from proximal to distal segments of the vessel due to the influence of various factors even in non-obstructive coronary artery disease (NOCAD). It is known that FFRCT is dependent on vessel-length, but the relationship with other vessel morphologies remains to be explained. Purpose To investigate morphological aspects of the vessels that influence FFRCT in NOCAD in the right coronary artery (RCA). Methods A total of 443 patients who underwent both FFRCT and invasive coronary angiography, with < 50% RCA stenosis, were evaluated. Enrolled RCA vessels were classified into two groups according to distal FFRCT: FFRCT ≤ 0.80 (n = 60) and FFRCT > 0.80 (n = 383). Vessel morphology (vessel length, lumen diameter, lumen volume, and plaque volume) and left-ventricular mass were assessed. The ratio of lumen volume and vessel length was defined as V/L ratio. Results Whereas vessel-length was almost the same between FFRCT ≤ 0.80 and > 0.80, lumen volume and V/L ratio were significantly lower in FFRCT ≤ 0.80. Distal FFRCT correlated with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). Among all vessel-related parameters, V/L ratio showed the highest correlation with distal FFRCT (r = 0.61, p < 0.0001). Multivariable analysis showed that calcified plaque volume was the strongest predictor of distal FFRCT, followed by V/L ratio (β-coefficient = 0.48, p = 0.03). V/L ratio was the strongest predictor of a distal FFRCT ≤ 0.80 (cut-off 8.1 mm3/mm, AUC 0.88, sensitivity 90.0%, specificity 76.7%, 95% CI 0.84–0.93, p < 0.0001). Conclusions Our study suggests that V/L ratio can be a measure to predict subclinical coronary perfusion disturbance. Clinical relevance statement A novel marker of the ratio of lumen volume to vessel length (V/L ratio) is the strongest predictor of a distal CT-derived fractional flow reserve (FFRCT) and may have the potential to improve the diagnostic accuracy of FFRCT. Key Points • Physiological FFRCT decline depends not only on vessel length but also on the lumen volume in non-obstructive coronary artery disease in the right coronary artery. • FFRCT correlates with plaque-related parameters (low-attenuation plaque, intermediate-attenuation plaque, and calcified plaque) and vessel-related parameters (proximal and distal vessel diameter, vessel length, lumen volume, and V/L ratio). • Of vessel-related parameters, V/L ratio is the strongest predictor of a distal FFRCT and an optimal cut-off value of 8.1 mm3/mm.

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Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease

Cited by 9 publications

References 30 publications

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFR_CT) in no apparent coronary artery disease

Impact of vessel morphology on CT-derived fractional-flow-reserve in non-obstructive coronary artery disease in right coronary artery

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Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease

Cited by 9 publications

References 30 publications

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

Impact of coronary bifurcation angle on computed tomography derived fractional flow reserve in coronary vessels with no apparent coronary artery disease

Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFRCT) in no apparent coronary artery disease

Impact of vessel morphology on CT-derived fractional-flow-reserve in non-obstructive coronary artery disease in right coronary artery

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Impact of ramus coronary artery on computed tomography derived fractional flow reserve (FFR_CT) in no apparent coronary artery disease