Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease
Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease
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DOI：
10.1016/j.jcct.2020.05.002
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发表时间：
2021-02-11
影响因子：
5.4
通讯作者：
Knaapen, Paul
中科院分区：
文献类型：
--
作者：
Bom, Michiel J.;Driessen, Roel S.;Knaapen, Paul
背景资料：本研究旨在研究使用狭窄和斑块测量以及对向心肌质量（V-sub）进行的全面现场冠状动脉计算机断层扫描血管造影（CCTA）对血流储备分数（FFR）定义的血流动力学阻塞性冠状动脉疾病（CAD）的诊断价值。此外，增量诊断价值的场外CT衍生的血流储备分数（FFRCT）进行了assessed.Methods：普罗维登斯入组的患者进行CCTA，然后有创血流储备分数询问所有主要冠状动脉。纳入狭窄>= 30%的血管进行分析。现场CCTA评估包括定性和定量狭窄（视觉分级和最小管腔面积，MLA）和斑块测量（特征和体积）以及V-sub。通过比较曲线下面积（AUC）来检验综合现场CCTA评估的诊断价值。结果：在236支血管（132例患者）中，MLA、正性重构、非钙化斑块体积和V-sub是血流动力学阻塞性CAD的独立现场CCTA预测因子（所有均为p < 0.05）。V-sub/MLA（2）优于所有这些现场CCTA参数（AUC = 0.85），V-sub相对于所有其他CCTA预测因子均呈增量（p = 0.02）。在亚组分析（n = 194支血管）中，FFRCT和V-sub/MLA（2）的诊断性能相似（AUC分别为0.89和0.85，p = 0.25）。此外，当FFRCT被添加到现场CCTA评估中时，诊断性能显著增加，尽管最低限度增加（AAUC = 0.03，p = 0.02）。结论：在全面的现场CCTA评估中，V-sub/MLA（2）表现出对血流动力学阻塞性CAD的最大诊断价值，并且V-sub增加了所有评估的CCTA指数。此外，增加FFRCT仅最低限度地提高了诊断性能，证明现场CCTA评估是FFRCT的合理替代方案。
Background: This study aimed to investigate the diagnostic value of comprehensive on-site coronary computed tomography angiography (CCTA) using stenosis and plaque measures and subtended myocardial mass (V-sub) for fractional flow reserve (FFR) defined hemodynamically obstructive coronary artery disease (CAD). Additionally, the incremental diagnostic value of off-site CT-derived FFR (FFRCT) was assessed.Methods: Prospectively enrolled patients underwent CCTA followed by invasive FFR interrogation of all major coronary arteries. Vessels with >= 30% stenosis were included for analysis. On-site CCTA assessment included qualitative and quantitative stenosis (visual grading and minimal lumen area, MLA) and plaque measures (characteristics and volumes), and V-sub. Diagnostic value of comprehensive on-site CCTA assessment was tested by comparing area under the curves (AUC). In vessels with available FFRCT, the incremental value of off-site FFRCT was tested.Results: In 236 vessels (132 patients), MLA, positive remodeling, non-calcified plaque volume, and V-sub were independent on-site CCTA predictors for hemodynamically obstructive CAD (p < 0.05 for all). V-sub/MLA(2) outperformed all these on-site CCTA parameters (AUC = 0.85) and V-sub was incremental to all other CCTA predictors (p = 0.02). In subgroup analysis (n = 194 vessels), diagnostic performance of FFRCT and V-sub/MLA(2) was similar (AUC 0.89 and 0.85 respectively, p = 0.25). Furthermore, diagnostic performance significantly albeit minimally increased when FFRCT was added to on-site CCTA assessment (AAUC = 0.03, p = 0.02).Conclusions: In comprehensive on-site CCTA assessment, V-sub/MLA(2) demonstrated greatest diagnostic value for hemodynamically obstructive CAD and V-sub was incremental to all evaluated CCTA indices. Additionally, adding FFRCT only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to FFRCT.