Trans-lesional fractional flow reserve gradient as derived from coronary CT improves patient management: ADVANCE registry.

Takagi, Hidenobu; Leipsic, Jonathon A; McNamara, Noah; Martin, Isabella; Fairbairn, Timothy A; Akasaka, Takashi; Nørgaard, Bjarne L; Berman, Daniel S; Chinnaiyan, Kavitha; Hurwitz-Koweek, Lynne M; Pontone, Gianluca; Kawasaki, Tomohiro; Rønnow Sand, Niels Peter; Jensen, Jesper M; Amano, Tetsuya; Poon, Michael; Øvrehus, Kristian A; Sonck, Jeroen; Rabbat, Mark G; Mullen, Sarah; De Bruyne, Bernard; Rogers, Campbell; Matsuo, Hitoshi; Bax, Jeroen J; Douglas, Pamela S; Patel, Manesh R; Nieman, Koen; Ihdayhid, Abdul Rahman

Takagi, Hidenobu; Leipsic, Jonathon A; McNamara, Noah; Martin, Isabella; Fairbairn, Timothy A; Akasaka, Takashi; Nørgaard, Bjarne L; Berman, Daniel S; Chinnaiyan, Kavitha; Hurwitz-Koweek, Lynne M; Pontone, Gianluca; Kawasaki, Tomohiro; Rønnow Sand, Niels Peter; Jensen, Jesper M; Amano, Tetsuya; Poon, Michael; Øvrehus, Kristian A; Sonck, Jeroen; Rabbat, Mark G; Mullen, Sarah; De Bruyne, Bernard; Rogers, Campbell; Matsuo, Hitoshi; Bax, Jeroen J; Douglas, Pamela S; Patel, Manesh R; Nieman, Koen; Ihdayhid, Abdul Rahman.

Afiliación

Takagi H; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Iwate Medical University Hospital, Iwate, Japan; Department of Diagnostic Radiology, Tohoku University Hospital, Miyagi, Japan.
Leipsic JA; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca.
McNamara N; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Martin I; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Fairbairn TA; Department of Cardiology, Liverpool Heart and Chest Hospital, University of Liverpool, Liverpool, UK.
Akasaka T; Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Nørgaard BL; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Berman DS; Division of Nuclear Imaging, Department of Imaging, Cedars-Sinai Heart Institute, Los Angeles, CA, USA.
Chinnaiyan K; Division of Cardiology, Beaumont Academic Heart and Vascular Group, Royal Oak, MI, USA.
Hurwitz-Koweek LM; Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Pontone G; Centro Cardiologico Monzino, IRCCS, Milan, Italy.
Kawasaki T; Cardiovascular Center, Shin Koga Hospital, Fukuoka, Japan.
Rønnow Sand NP; Cardiac Research Unit, Institute of Regional Health Research, University Hospital of Southern DK, Esbjerg and University of Southern DK, Denmark.
Jensen JM; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Amano T; Department of Cardiology, Aichi Medical University, Aichi, Japan.
Poon M; Department of Noninvasive Cardiac Imaging, Northwell Health, New York, NY, USA.
Øvrehus KA; Department of Cardiology, Odense University Hospital, Denmark.
Sonck J; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
Rabbat MG; Division of Cardiology, Loyola University Chicago, Chicago, IL, USA.
Mullen S; HeartFlow Inc., Redwood City, CA, USA.
De Bruyne B; Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium; Department of Cardiology, University Hospital of Lausanne, Lausanne, CH, USA.
Rogers C; HeartFlow Inc., Redwood City, CA, USA.
Matsuo H; Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan.
Bax JJ; Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Douglas PS; Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Patel MR; Division of Cardiology, Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
Nieman K; Department of Cardiovascular Medicine and Radiology, Stanford University, Stanford, CA, USA.
Ihdayhid AR; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada; Department of Cardiology, Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, University of Western Australia, Perth, Australia.

J Cardiovasc Comput Tomogr ; 16(1): 19-26, 2022.

Article en En | MEDLINE | ID: mdl-34518113

ABSTRACT

ABSTRACT

BACKGROUND:

The role of change in fractional flow reserve derived from CT (FFRCT) across coronary stenoses (ΔFFRCT) in guiding downstream testing in patients with stable coronary artery disease (CAD) is unknown.

OBJECTIVES:

To investigate the incremental value of ΔFFRCT in predicting early revascularization and improving efficiency of catheter laboratory utilization. MATERIALS Patients with CAD on coronary CT angiography (CCTA) were enrolled in an international multicenter registry. Stenosis severity was assessed as per CAD-Reporting and Data System (CAD-RADS), and lesion-specific FFRCT was measured 2 âcm distal to stenosis. ΔFFRCT was manually measured as the difference of FFRCT across visible stenosis.

RESULTS:

Of 4730 patients (66 â± â10 years; 34% female), 42.7% underwent ICA and 24.7% underwent early revascularization. ΔFFRCT remained an independent predictor for early revascularization (odds ratio per 0.05 increase [95% confidence interval], 1.31 [1.26-1.35]; p â< â0.001) after adjusting for risk factors, stenosis features, and lesion-specific FFRCT. Among the 3 models (model 1 risk factors â+ âstenosis type and location â+ âCAD-RADS; model 2 model 1 â+ âFFRCT; model 3 model 2 â+ âΔFFRCT), model 3 improved discrimination compared to model 2 (area under the curve, 0.87 [0.86-0.88] vs 0.85 [0.84-0.86]; p â< â0.001), with the greatest incremental value for FFRCT 0.71-0.80. ΔFFRCT of 0.13 was the optimal cut-off as determined by the Youden index. In patients with CAD-RADS ≥3 and lesion-specific FFRCT ≤0.8, a diagnostic strategy incorporating ΔFFRCT >0.13, would potentially reduce ICA by 32.2% (1638-1110, p â< â0.001) and improve the revascularization to ICA ratio from 65.2% to 73.1%.

CONCLUSIONS:

ΔFFRCT improves the discrimination of patients who underwent early revascularization compared to a standard diagnostic strategy of CCTA with FFRCT, particularly for those with FFRCT 0.71-0.80. ΔFFRCT has the potential to aid decision-making for ICA referral and improve efficiency of catheter laboratory utilization.

Asunto(s)

Enfermedad de la Arteria Coronaria; Estenosis Coronaria; Reserva del Flujo Fraccional Miocárdico; Angiografía por Tomografía Computarizada; Angiografía Coronaria; Enfermedad de la Arteria Coronaria/diagnóstico por imagen; Enfermedad de la Arteria Coronaria/terapia; Estenosis Coronaria/diagnóstico por imagen; Estenosis Coronaria/terapia; Vasos Coronarios/diagnóstico por imagen; Femenino; Humanos; Masculino; Valor Predictivo de las Pruebas; Sistema de Registros; Índice de Severidad de la Enfermedad; Tomografía Computarizada por Rayos X

Palabras clave

Coronary artery disease (CAD); Coronary computed tomography angiography (CCTA); Fractional flow reserve (FFR); Fractional flow reserve derived from coronary computed tomography (FFR(CT))

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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Enfermedad de la Arteria Coronaria / Estenosis Coronaria / Reserva del Flujo Fraccional Miocárdico Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male Idioma: En Revista: J Cardiovasc Comput Tomogr Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / RADIOLOGIA Año: 2022 Tipo del documento: Article País de afiliación: Japón

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