Author + information
- Roel Driessen,
- Wijnand Stuijfzand,
- Pieter Raijmakers,
- Ibrahim Danad,
- James Min,
- Jonathon Leipsic,
- Amir Ahmadi,
- Jagat Narula,
- Peter van de Ven,
- Marc Huisman,
- Adriaan Lammertsma,
- Albert van Rossum,
- Niels Van Royen and
- Paul Knaapen
Background: Next to coronary lesion severity, atherosclerotic plaque characteristics may also affect downstream myocardial perfusion. The purpose of the present study was to evaluate the association between quantitative plaque burden and plaque morphology obtained using coronary computed tomography angiography (CCTA) and quantitative myocardial perfusion obtained using [15O]H2O positron emission tomography (PET) as well as fractional flow reserve (FFR) derived invasively.
Methods: 208 patients (63% men, age 58 ± 8.7 years) with suspected coronary artery disease were prospectively included. All patients underwent 256-slice CCTA, [15O]H2O PET, and invasive FFR measurements. CCTA derived quantitative plaque burden and morphology were assessed using commercially available software and then compared with PET perfusion and FFR.
Results: Atherosclerotic plaques were present in 179 (86%) patients and 414 of 610 (68%) evaluable coronary arteries. On a per-vessel basis, traditional coronary stenosis indices, such as plaque length and volume, minimal lumen area, plaque burden, and stenosis percentage, were significantly associated with impaired hyperemic myocardial blood flow (MBF) and FFR. In addition, morphological features, such as mixed plaques, positive remodeling (PR), and low attenuation plaque (LAP), also displayed a negative impact on hyperemic MBF and FFR. Multivariable analysis revealed that the morphological feature of PR was independently related to impaired hyperemic MBF as well as an unfavorable FFR (p = 0.004 and p = 0.007, respectively), next to stenosis percentage (p = 0.001 and p < 0.001, respectively), and non-calcified plaque volume (p < 0.001 and p = 0.010, respectively).
Conclusions: Positive remodeling and non-calcified plaque volume are associated with detrimental downstream hyperemic myocardial perfusion and FFR, independent from lesion severity.
Moderated Poster Contributions
Non Invasive Imaging Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:00 a.m.-11:10 a.m.
Session Title: Noninvasive Assessment of Coronary Flow Reserve: Clinical Implications
Abstract Category: 27. Non Invasive Imaging: CT/Multimodality, Angiography, and Non-CT Angiography
Presentation Number: 1136M-11
- 2017 American College of Cardiology Foundation