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Relationship of Plaque Features at Coronary CT to Coronary Hemodynamics and Cardiovascular Events

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Author(s)
Seokhun YangMasahiro HoshinoBon-Kwon KooTaishi YonetsuJinlong ZhangDoyeon HwangEun-Seok ShinJoon-Hyung DohChang-Wook NamJianan WangShaoliang ChenNobuhiro TanakaHitoshi MatsuoTakashi KuboHyuk-Jae ChangTsunekazu KakutaJagat Narula
Keimyung Author(s)
Nam, Chang Wook
Department
Dept. of Internal Medicine (내과학)
Journal Title
Radiology
Issued Date
2022
Volume
305
Issue
3
Abstract
Background:
Plaque assessments with coronary CT angiography (CCTA) and coronary flow indexes have prognostic implications.

Purpose:
To investigate the association and additive prognostic value of plaque burden and characteristics at CCTA with coronary pressure and flow.

Materials and Methods:
Data of patients with coronary artery disease who underwent CCTA within 90 days before physiologic assessments at tertiary cardiovascular centers between January 2011 and December 2018 were retrospectively analyzed, which included fractional flow reserve (FFR), resting distal coronary artery pressure (Pd)-to–aortic pressure (Pa) ratio (hereafter, Pd/Pa), coronary flow reserve (CFR), hyperemic flow (1/hyperemic mean transit time [Tmn]), resting flow (1/resting Tmn), and index of microcirculatory resistance (IMR). Four high-risk plaque (HRP) attributes at CCTA defined high disease burden (plaque burden, ≥70%; minimum lumen area, <4 mm2) and adverse plaque (low-attenuation plaque, positive remodeling). Their lesion-specific relationships with coronary hemodynamic parameters and major adverse cardiovascular events (MACE) were investigated using a generalized estimating equation and marginal Cox model.

Results:
Among 406 lesions from 335 patients (mean age, 67 years ± 10 [SD]; 259 men), high disease burden is predicted by FFR (odds ratio [OR], 0.55; P < .001), resting Pd/Pa (OR, 0.47; P < .001), CFR (OR, 0.85; P = .004), and hyperemic flow (OR, 0.91; P = .03), and adverse plaque by FFR (OR, 0.67; P < .001), resting Pd/Pa (OR, 0.69; P = .001), hyperemic flow (OR, 0.76; P = .006), resting flow (OR, 0.54; P = .001), and IMR (OR, 1.27; P = .008). High disease burden (hazard ratio [HR], 4.0; P = .004) and adverse plaque (HR, 2.7; P = .02) were associated with a higher risk of MACE (n = 27) over median 2.9-year follow-up. In six lesion subsets with normal flow or pressure, at least three HRP attributes predicted a higher MACE rate (HR range, 2.6–6.3).

Conclusion:
High-risk plaque features and plaque burden at coronary CT angiography were associated with cardiovascular events independent of coronary hemodynamic parameters.
Keimyung Author(s)(Kor)
남창욱
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1527-1315
Source
https://pubs.rsna.org/doi/10.1148/radiol.213271
DOI
10.1148/radiol.213271
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44581
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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