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

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Author(s)
Seokhun YangGilwoo ChoiJinlong ZhangJoo Myung LeeDoyeon HwangJoon-Hyung DohChang-Wook NamEun-Seok ShinYoung-Seok ChoSu-Yeon ChoiEun Ju ChunBjarne L. NørgaardKoen NiemanHiromasa OtakeMartin PenickaBernard De BruyneTakashi KuboTakashi AkasakaCharles A. Taylorand Bon-Kwon Koo
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Front Cardiovasc Med
Issued Date
2021
Volume
8
Keyword
acute coronary syndromeatherosclerosislocal hemodynamic parameterscoronary artery diseasecoronary CT angiography
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 (FFRCT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFRCT across the lesion (ΔFFRCT) 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 ΔFFRCT 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 FFRCT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFRCT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFRCT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFRCT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT had a similar or superior discrimination ability to that with FFRCT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFRCT 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 FFRCT.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Citation
Seokhun Yang et al. (2021). Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome. Front Cardiovasc Med, 8, 713835. doi: 10.3389/fcvm.2021.713835
Type
Article
ISSN
2297-055X
Source
https://www.frontiersin.org/articles/10.3389/fcvm.2021.713835/full
DOI
10.3389/fcvm.2021.713835
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44026
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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