association between atherosclerotic plaque characteristics by computed tomography angiography (CTA), and lesion ischemia by fractional flow reserve (FFR). High-risk plaque characteristics by coronary CTA were defined as: (I) positive remodeling, lesion diameter/reference diameter >1.10; (II) low attenuation plaque, any voxel <30 HU; and (III) spotty calcifications, nodular calcified plaque <3 mm. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 [odds ratio (OR): 4.0, P<0.001] and ≥ 2 (OR: 12.1, P<0.001) high-risk features. These findings were risk feature dependent, with positive remodeling (OR: 5.3, P<0.001) and low attenuation plaque (OR: 2.1, P=0.038) associated with ischemia, but not spotty calcification (10). feasibility fully in 57 patients who underwent CCTA to intravascular ultrasound virtual CCTA volume Assessment intravascular virtual histology including percent percent atheroma and the impression of “vulnerable plaque” independently predicted myocardial ischemia by single-photon emission computed tomography 254 patients and reported that noncalcified plaque volume predicted an FFR cutoff value of 0.80, independent of stenosis severity. These results were confirmed by a recent post hoc analysis from the single-center PACIFIC (Prospective Comparison of Cardiac PET/ CT, SPECT/CT Perfusion Imaging and CCTA With Invasive Coronary Angiography) trial showing that positive remodeling and noncalcified atherosclerotic plaque volume were associated with decreased absolute myocardial blood flow by [ 15 O]H 2 O PET and invasive FFR (23). The NXT (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps) trial demonstrated that the diagnostic accuracy of FFR CT (AUC: 0.90; 95% confidence interval: 0.87 to 0.94) was significantly greater than that of CCTA alone (0.81; 95% confidence interval: 0.76 to 0.87) The PACIFIC study also compared the diagnostic accuracy of various modalities using invasive 3-vessel FFR as the gold standard and found that the AUC on a per-vessel basis was significantly greater for FFR CT (0.94) compared to CCTA (0.83), SPECT (0.70), and PET (0.87) (P<0.001 for all)
Paper
Full text
Machine learning-based advances in coronary computed tomography angiography.
Semantic Scholar · Medicine · 2021
Abstract
association between atherosclerotic plaque characteristics by computed tomography angiography (CTA), and lesion ischemia by fractional flow reserve (FFR). High-risk plaque characteristics by coronary CTA were defined as: (I) positive remodeling, lesion diameter/reference diameter >1.10; (II) low attenuation plaque, any voxel <30 HU; and (III) spotty calcifications, nodular calcified plaque <3 mm. In multivariable analyses, a stepwise increased risk of ischemia was observed for 1 [odds ratio (OR): 4.0, P<0.001] and ≥ 2 (OR: 12.1, P<0.001) high-risk features. These findings were risk feature dependent, with positive remodeling (OR: 5.3, P<0.001) and low attenuation plaque (OR: 2.1, P=0.038) associated with ischemia, but not spotty calcification (10). feasibility fully in 57 patients who underwent CCTA to intravascular ultrasound virtual CCTA volume Assessment intravascular virtual histology including percent percent atheroma and the impression of “vulnerable plaque” independently predicted myocardial ischemia by single-photon emission computed tomography 254 patients and reported that noncalcified plaque volume predicted an FFR cutoff value of 0.80, independent of stenosis severity. These results were confirmed by a recent post hoc analysis from the single-center PACIFIC (Prospective Comparison of Cardiac PET/ CT, SPECT/CT Perfusion Imaging and CCTA With Invasive Coronary Angiography) trial showing that positive remodeling and noncalcified atherosclerotic plaque volume were associated with decreased absolute myocardial blood flow by [ 15 O]H 2 O PET and invasive FFR (23). The NXT (Analysis of Coronary Blood Flow Using CT Angiography: Next Steps) trial demonstrated that the diagnostic accuracy of FFR CT (AUC: 0.90; 95% confidence interval: 0.87 to 0.94) was significantly greater than that of CCTA alone (0.81; 95% confidence interval: 0.76 to 0.87) The PACIFIC study also compared the diagnostic accuracy of various modalities using invasive 3-vessel FFR as the gold standard and found that the AUC on a per-vessel basis was significantly greater for FFR CT (0.94) compared to CCTA (0.83), SPECT (0.70), and PET (0.87) (P<0.001 for all)