Comparison of Fractional Myocardial Mass, a Vessel-Specific Myocardial Mass-At-Risk, With Coronary Angiographic Scoring Systems for Predicting Myocardial Ischemia
- Author(s)
- Hyeon-Cheol Gwon; Seung Hyuk Choi; Hyung Yoon Kim; Joon-Hyung Doh; Hong-Seok Lim; Chang-Wook Nam; Eun-Seok Shin; Bon-Kwon Koo; Joo Myung Lee; Taek Kyu Park; Jeong Hoon Yang; Young Bin Song; Joo-Yong Hahn; Sang-Hoon Lee; Sung Mok Kim; Yeonhyeon Choe; Jin-Ho Choi
- Keimyung Author(s)
- Nam, Chang Wook
- Department
- Dept. of Internal Medicine (내과학)
- Journal Title
- Journal of cardiovascular computed tomography
- Issued Date
- 2019
- Keyword
- Fractional myocardial mass; Angiographic scores; Myocardial ischemic burden
- Abstract
- Aims:
The burden of coronary artery disease has been assessed by various semi-quantitative angiographic scores, which are frequently different each other. A non-invasive and quantitative modality may substitute angiographic sores for prognostic implication and decision of revascularization strategy. We compared fractional myocardial mass (FMM) with angiographic scores for predicting myocardial ischemia.
Methods:
In this multicenter registry, 411 patients who underwent coronary computed tomography angiography (CCTA) were followed by invasive coronary angiography and fractional flow reserve (FFR) measurement. CCTA–derived %FMM with diameter stenosis≥70% (%FMM-70) or ≥50% (%FMM-50) were compared with 9 angiographic scores (APPROACH, Duke Jeopardy, BARI, CASS, SYNTAX, Jenkins, BCIS-1, Leaman, Modified Duke) and were tested regarding their performance for predicting FFR≤0.80.
Results:
The performance of %FMM-70 and %FMM-50 were similar to most angiographic scores (%FMM-70, c-statistics = 0.74; %FMM-50, 0.73; angiographic scores, 0.68–0.77). The frequency of FFR≤0.80 increased consistently according to %FMM-70, %FMM-50, and all angiographic scores (p < 0.001, all). The optimal cutoff of %FMM-50 and %FMM-70 for FFR≤0.80 were ≥36.3% and ≥8.7%, respectively. Using these cutoffs, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of %FMM-50 were 81%, 55%, 3%, 67%, 71%, and of %FMM-70 were 67%, 78%, 82%, 61%, 71%.
Conclusion:
%FMM was comparable to angiographic scores for prediction of functional stenosis defined by FFR≤0.80. The integration of the severity of stenosis and the amount of subtended myocardium may improve the detection of the functional significance of vessel.
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