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Value of semiquantitative assessment of high-risk plaque features on coronary CT angiography over stenosis in selection of studies for FFRct

  • Yuka Otaki
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Donghee Han
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Eyal Klein
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Heidi Gransar
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Rebekah H. Park
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Balaji Tamarappoo
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Sean W. Hayes
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • John D. Friedman
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Louise E.J. Thomson
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Piotr J. Slomka
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Damini Dey
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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  • Victor Cheng
    Affiliations
    Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
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  • Robert JH. Miller
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA

    Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
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  • Daniel S. Berman
    Correspondence
    Corresponding author. 8700 Beverly Boulevard, Los Angeles, CA, 90048.
    Affiliations
    Department of Imaging (Division of Nuclear Medicine), Medicine, and Biomedical Sciences, Cedars-Sinai Medical Center, The Cedars-Sinai Heart Institute, Los Angeles, CA, USA
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      Abstract

      Introduction

      The degree of stenosis on coronary CT angiography (CCTA) guides referral for CT-derived flow reserve (FFRct). We sought to assess whether semiquantitative assessment of high-risk plaque (HRP) features on CCTA improves selection of studies for FFRct over stenosis assessment alone.

      Methods

      Per-vessel FFRct was computed in 1,395 vessels of 836 patients undergoing CCTA with 25–99% maximal stenosis. By consensus analysis, stenosis severity was graded as 25–49%, 50–69%, 70–89%, and 90–99%. HRPs including low attenuation plaque (LAP), positive remodeling (PR), and spotty calcification (SC) were assessed in lesions with maximal stenosis. Lesion FFRct was measured distal to the lesion with maximal stenosis, and FFRct<0.80 was defined as abnormal. Association of HRP and abnormal lesion FFRct was evaluated by univariable and multivariable logistic regression models.

      Results

      The frequency of abnormal lesion FFRct increased with increase of stenosis severity across each stenosis category (25–49%:6%; 50–69%:30%; 70–89%:54%; 90–99%:91%, p ​< ​0.001). Univariable analysis demonstrated that stenosis severity, LAP, and PR were predictive of abnormal lesion FFRct, while SC was not. In multivariable analyses considering stenosis severity, presence of PR, LAP, and PR and/or LAP were independently associated with abnormal FFRct: Odds ratio 1.58, 1.68, and 1.53, respectively (p ​< ​0.02 for all). The presence of PR and/or LAP increased the frequency of abnormal FFRct with mild stenosis (p ​< ​0.05) with a similar trend with 70–89% stenosis. The combination of 2 HRP (LAP and PR) identified more lesions with FFR < 0.80 than only 1 HRP.

      Conclusions

      Semiquantitative visual assessment of high-risk plaque features may improve the selection of studies for FFRct.

      Keywords

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