Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome

Seokhun Yang; Gilwoo Choi; Jinlong Zhang; Joo Myung Lee; Doyeon Hwang; Joon-Hyung Doh; Chang-Wook Nam; Eun-Seok Shin; Young-Seok Cho; Su-Yeon Choi; Eun Ju Chun; Bjarne L Nørgaard; Koen Nieman; Hiromasa Otake; Martin Penicka; Bernard De Bruyne; Takashi Kubo; Takashi Akasaka; Charles A Taylor; Bon-Kwon Koo

doi:10.3389/fcvm.2021.713835

Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome

Front Cardiovasc Med. 2021 Sep 13:8:713835. doi: 10.3389/fcvm.2021.713835. eCollection 2021.

Authors

Seokhun Yang¹, Gilwoo Choi², Jinlong Zhang³, Joo Myung Lee⁴, Doyeon Hwang¹, Joon-Hyung Doh⁵, Chang-Wook Nam⁶, Eun-Seok Shin⁷, Young-Seok Cho⁸, Su-Yeon Choi⁹, Eun Ju Chun¹⁰, Bjarne L Nørgaard¹¹, Koen Nieman¹², Hiromasa Otake¹³, Martin Penicka¹⁴, Bernard De Bruyne¹⁴, Takashi Kubo¹⁵, Takashi Akasaka¹⁵, Charles A Taylor^{2

16}, Bon-Kwon Koo^{1

17}

Affiliations

¹ Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea.
² HeartFlow Inc., Redwood City, CA, United States.
³ Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
⁴ Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
⁵ Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
⁶ Department of Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea.
⁷ Department of Cardiology, Ulsan Hospital, Ulsan, South Korea.
⁸ Cardiovascular Center, Sejong General Hospital, Incheon, South Korea.
⁹ Department of Medicine, Healthcare System Gangnam Center, Seoul National University, Seoul, South Korea.
¹⁰ Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
¹¹ Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
¹² School of Medicine, Cardiovascular Institute, Stanford University, Stanford, CA, United States.
¹³ Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
¹⁴ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
¹⁵ Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
¹⁶ Department of Bioengineering, Stanford University, Stanford, CA, United States.
¹⁷ Institute on Aging, Seoul National University, Seoul, South Korea.

Abstract

Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated. Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1-24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFR_CT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFR_CT across the lesion (ΔFFR_CT) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared. Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFR_CT were strongly correlated with each other (all p < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFR_CT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFR_CT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFR_CT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFR_CT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFR_CT ≤ 0.80, high-risk plaque, and ΔFFR_CT had a similar or superior discrimination ability to that with FFR_CT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFR_CT did not improve the model performance. Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFR_CT.

Keywords: acute coronary syndrome; atherosclerosis; coronary CT angiography; coronary artery disease; local hemodynamic parameters.

Grants and funding

R01 HL141712/HL/NHLBI NIH HHS/United States