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Prognosis of CT-derived Fractional Flow Reserve in the Prediction of Clinical Outcomes.
McNabney, Charis G; Sellers, Stephanie L; Wilson, Ryan J A; Hart, Shmuel; Rosenblatt, Samuel A; Murphy, Darra T; Blanke, Philipp; Ahmadi, Amir A; Halankar, Jaydeep; Attinger-Toller, Adrian; Godoy Zamorano, Marcelo; Li Yu, Janice Wong; Nørgaard, Bjarne L; Leipsic, Jonathon A; Weir-McCall, Jonathan R.
Afiliação
  • McNabney CG; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Sellers SL; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Wilson RJA; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Hart S; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Rosenblatt SA; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Murphy DT; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Blanke P; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Ahmadi AA; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Halankar J; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Attinger-Toller A; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Godoy Zamorano M; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Li Yu JW; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Nørgaard BL; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Leipsic JA; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
  • Weir-McCall JR; Department of Radiology (C.G.M., S.L.S., S.H., S.A.R., D.T.M., P.B., J.H., M.G.Z., J.A.L., J.R.W.M.), Centre for Heart Lung Innovation (S.L.S., J.W.L.Y., J.A.L.), and Department of Cardiology (A.A.A., A.A.T., J.A.L.), St Paul's Hospital and University of British Columbia, 1081 Burrard St., Vancouver
Radiol Cardiothorac Imaging ; 1(2): e190021, 2019 Jun.
Article em En | MEDLINE | ID: mdl-33778504
ABSTRACT

PURPOSE:

To examine the prognostic implication of fractional flow reserve (FFR) derived from coronary CT (FFRCT) in routine clinical practice. MATERIALS AND

METHODS:

Patients referred for FFRCT analysis at a single center between October 2015 and June 2017 were retrospectively included and followed up for rates of invasive angiography and clinical events. Two hundred seven patients underwent successful FFRCT analysis with seven lost to follow-up, leaving 200 (mean age ± standard deviation, 62.4 years ± 10.0; 49 [24.5%] women) patients for analysis. At coronary CT angiography, patients were categorized as having significant stenosis (SS) in the presence of a diameter stenosis greater than or equal to 50% (hereafter, SS positive) and flow limitation in the presence of a postlesion (that is, FFRCT measured 2 cm to the distal aspect of the lesion) FFRCT less than 0.80 (hereafter, FFRCT positive). Vessel-oriented clinical events (VOCEs) were defined as vessel-related late revascularization (>90 days), myocardial infarction, and cardiac mortality.

RESULTS:

At CT angiography, 130 (65%) studies were SS positive and 63 (31.5%) were FFRCT positive. At median follow-up of 477 days (range, 252-859 days), there were 26 VOCE end points in 22 patients 22 revascularizations and four nonfatal myocardial infarctions. VOCE end points occurred in zero of 58 (0%) of SS-negative and FFRCT negative patients, in eight of 79 (10.1%) of SS-positive and FFRCT-negative patients, in zero of 12 (0%) of SS-negative and FFRCT-positive patients, and in 18 of 51 (35.3%) of SS-positive and FFRCT-positive patients (log-rank χ2 = 30.1; P < .001). At multivariable Cox regression, both FFRCT (hazard ratio per 0.1 decrease, 1.54 [95% confidence interval 1.1, 2.2] P = .013) and stenosis (hazard ratio per unit increase, 2.16 [95% confidence interval 1.25, 3.72] P = .006) were independently associated with VOCE.

CONCLUSION:

Stenosis and FFRCT are independent predictors of intermediate-term outcomes. In the absence of a stenosis greater than 50%, a positive FFRCT result is not associated with an increased intermediate risk.© RSNA, 2019Supplemental material is available for this article.See also commentary by Fairbairn and Bull in this issue.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies / Risk_factors_studies Idioma: En Revista: Radiol Cardiothorac Imaging Ano de publicação: 2019 Tipo de documento: Article
Texto completo
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PubMed Links
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Tipo de estudo: Prognostic_studies / Risk_factors_studies Idioma: En Revista: Radiol Cardiothorac Imaging Ano de publicação: 2019 Tipo de documento: Article