Prognostic Value of Coronary CT Angiography-Derived Fractional Flow Reserve in Non-obstructive Coronary Artery Disease: A Prospective Multicenter Observational Study

Fan Zhou; Qian Chen; Xiao Luo; Wei Cao; Ziwen Li; Bo Zhang; U Joseph Schoepf; Callum E Gill; Lili Guo; Hong Gao; Qingyao Li; Yibing Shi; Tingting Tang; Xiaochen Liu; Honglin Wu; Dongqing Wang; Feng Xu; Dongsheng Jin; Sheng Huang; Haige Li; Changjie Pan; Hongmei Gu; Lixiang Xie; Ximing Wang; Jing Ye; Jianwei Jiang; Hanqing Zhao; Xiangming Fang; Yi Xu; Wei Xing; Xiaohu Li; Xindao Yin; Guang Ming Lu; Long Jiang Zhang

doi:10.3389/fcvm.2021.778010

Prognostic Value of Coronary CT Angiography-Derived Fractional Flow Reserve in Non-obstructive Coronary Artery Disease: A Prospective Multicenter Observational Study

Front Cardiovasc Med. 2022 Jan 31:8:778010. doi: 10.3389/fcvm.2021.778010. eCollection 2021.

Authors

Fan Zhou¹, Qian Chen², Xiao Luo³, Wei Cao⁴, Ziwen Li⁵, Bo Zhang⁶, U Joseph Schoepf⁷, Callum E Gill⁷, Lili Guo⁸, Hong Gao⁹, Qingyao Li¹⁰, Yibing Shi¹¹, Tingting Tang¹², Xiaochen Liu¹³, Honglin Wu¹⁴, Dongqing Wang¹⁵, Feng Xu¹⁶, Dongsheng Jin¹⁷, Sheng Huang¹⁸, Haige Li¹⁹, Changjie Pan²⁰, Hongmei Gu²¹, Lixiang Xie²², Ximing Wang²³, Jing Ye²⁴, Jianwei Jiang²⁵, Hanqing Zhao²⁶, Xiangming Fang²⁷, Yi Xu²⁸, Wei Xing²⁹, Xiaohu Li³⁰, Xindao Yin², Guang Ming Lu¹, Long Jiang Zhang¹

Affiliations

¹ Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
² Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
³ Department of Radiology, People's Hospital of Maanshan, Maanshan, China.
⁴ Department of Radiology, The First People's Hospital of Xuzhou, Xuzhou, China.
⁵ Department of Radiology, Lianyungang Clinical Medical College of Nanjing Medical University, Lianyungang, China.
⁶ Department of Radiology, Taizhou People's Hospital, Taizhou, China.
⁷ Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States.
⁸ Department of Medical Imaging, The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University, Huai'an, China.
⁹ Department of Medical Imaging, Qinhuai Medical Region of Jinling Hospital, Nanjing, China.
¹⁰ Department of Radiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.
¹¹ Department of Diagnostic Radiology, Xuzhou Central Hospital, Xuzhou, China.
¹² Department of Diagnostic Radiology, Yancheng No.1 Hospital, Affiliated Hospital of Nantong University, Yancheng, China.
¹³ Department of Medical Imaging, Hai'an City People's Hospital, Haian, China.
¹⁴ Department of Radiology, The Affiliated Wujin Hospital of Jiangsu University, Changzhou, China.
¹⁵ Department of Medical Imaging, Affiliated Hospital of Jiangsu University, Zhenjiang, China.
¹⁶ Department of Medical Imaging, The Affiliated Suqian First People's Hospital of Nanjing Medical University, Suqian, China.
¹⁷ Department of Radiology, Jiangsu Province Official Hospital, Jiangsu Jiankang Vocational College, Nanjing, China.
¹⁸ Department of Radiology, The Second Affiliated Hospital of Nantong University, Nantong, China.
¹⁹ Department of Medical Imaging, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
²⁰ Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China.
²¹ Medical Imaging Center, Affiliated Hospital of Nantong University, Nantong, China.
²² Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
²³ Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China.
²⁴ Radiology Department, Subei People's Hospital of Jiangsu Province, Yangzhou, China.
²⁵ Department of Medical Imaging, Affiliated Hospital of Jiangnan University, Wuxi, China.
²⁶ Department of Medical Imaging, The Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou, China.
²⁷ Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
²⁸ Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
²⁹ Department of Radiology, Third Affiliated Hospital of Soochow University, Soochow University, Changzhou, China.
³⁰ Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.

Abstract

Coronary artery disease (CAD) is a major contributor to morbidity and mortality worldwide. Myocardial ischemia may occur in patients with normal or non-obstructive CAD on invasive coronary angiography (ICA). The comprehensive evaluation of coronary CT angiography (CCTA) integrated with fractional flow reserve derived from CCTA (CT-FFR) to CAD may be essential to improve the outcomes of patients with non-obstructive CAD. China CT-FFR Study-2 (ChiCTR2000031410) is a large-scale prospective, observational study in 29 medical centers in China. The primary purpose is to uncover the relationship between the CCTA findings (including CT-FFR) and the outcome of patients with non-obstructive CAD. At least 10,000 patients with non-obstructive CAD but without previous revascularization will be enrolled. A 5-year follow-up will be performed. The primary endpoint is the occurrence of major adverse cardiovascular events (MACE), including all-cause mortality, non-fatal myocardial infarct, unplanned revascularization, and hospitalization for unstable angina. Clinical characteristics, laboratory and imaging examination results will be collected to analyze their prognostic value.

Keywords: coronary computed tomography angiography; coronary plaque assessment; fractional flow reserve; major adverse cardiovascular events; non-obstructive coronary artery disease.