Long-term prognostic implications of hemodynamic and plaque assessment using coronary CT angiography

Seokhun Yang; Krista Lesina; Joon-Hyung Doh; Sanda Jegere; Andrejs Erglis; Jonathon A Leipsic; Eun Ju Chun; Gilwoo Choi; Michiel Schaap; Christopher Zarins; Charles A Taylor; William F Fearon; Jagat Narula; Bon-Kwon Koo

doi:10.1016/j.atherosclerosis.2023.02.005

Long-term prognostic implications of hemodynamic and plaque assessment using coronary CT angiography

Atherosclerosis. 2023 May:373:58-65. doi: 10.1016/j.atherosclerosis.2023.02.005. Epub 2023 Feb 27.

Authors

Affiliations

¹ Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
² Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia.
³ Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
⁴ Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
⁵ Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
⁶ HeartFlow, Inc., Mountain View, CA, USA.
⁷ Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
⁸ Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. Electronic address: bkkoo@snu.ac.kr.

PMID: 36872186
DOI: 10.1016/j.atherosclerosis.2023.02.005

Abstract

Background and aims: Hemodynamic and plaque characteristics can be analyzed using coronary CT angiography (CTA). We aimed to explore long-term prognostic implications of hemodynamic and plaque characteristics using coronary CT angiography (CTA).

Methods: Invasive fractional flow reserve (FFR) and CTA-derived FFR (FFR_CT) were undertaken for 136 lesions in 78 vessels and followed-up to 10 years until December 2020. FFR_CT, wall shear stress (WSS), change in FFR_CT across the lesion (ΔFFR_CT), total plaque volume (TPV), percent atheroma volume (PAV), and low-attenuation plaque volume (LAPV) for target lesions [L] and vessels [V] were obtained by independent core laboratories. Their collective influence was evaluated for the clinical endpoints of target vessel failure (TVF) and target lesion failure (TLF).

Results: During a median follow-up of 10.1 years, PAV[V] (per 10% increase, HR 2.32 [95% CI 1.11-4.86], p = 0.025), and FFR_CT[V] (per 0.1 increase, HR 0.56 [95% CI 0.37-0.84], p = 0.006) were independent predictors of TVF for the per-vessel analysis, and WSS[L] (per 100 dyne/cm² increase, HR 1.43 [1.09-1.88], p = 0.010), LAPV[L] (per 10 mm³ increase, HR 3.81 [1.16-12.5], p = 0.028), and ΔFFR_CT[L] (per 0.1 increase, HR 1.39 [1.02-1.90], p = 0.040) were independent predictors of TLF for the per-lesion analysis after adjustment for clinical and lesion characteristics. The addition of both plaque and hemodynamic predictors improved the predictability for 10-year TVF and TLF of clinical and lesion characteristics (all p < 0.05).

Conclusions: Vessel- and lesion-level hemodynamic characteristics, and vessel-level plaque quantity, and lesion-level plaque compositional characteristics assessed by CTA offer independent and additive long-term prognostic value.

Trial registration: ClinicalTrials.gov NCT01189331.

Keywords: Fractional flow reserve; Long-term prognosis; Low-attenuation plaque; Percent atheroma volume; Total plaque volume; Wall shear stress.

MeSH terms

Computed Tomography Angiography
Coronary Angiography
Coronary Artery Disease* / diagnostic imaging
Coronary Artery Disease* / pathology
Coronary Stenosis* / pathology
Coronary Vessels / diagnostic imaging
Coronary Vessels / pathology
Fractional Flow Reserve, Myocardial*
Hemodynamics
Humans
Plaque, Atherosclerotic* / pathology
Predictive Value of Tests
Prognosis
Tomography, X-Ray Computed

Associated data

ClinicalTrials.gov/NCT01189331