Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease

Michiel J. Bom; Roel S. Driessen; Akira Kurata; Pepijn A. van Diemen; Henk Everaars; Stefan P. Schumacher; Ruben W. de Winter; Peter M. van de Ven; Albert C. van Rossum; Charles A. Taylor; James K. Min; Jonathon A. Leipsic; Ibrahim Danad; Paul Knaapen

doi:10.1016/j.jcct.2020.05.002

Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease

Michiel J. Bom
, Roel S. Driessen
, Akira Kurata
, Pepijn A. van Diemen
, Henk Everaars
, Stefan P. Schumacher
, Ruben W. de Winter
, Peter M. van de Ven
, Albert C. van Rossum
, Charles A. Taylor
, James K. Min
, Jonathon A. Leipsic
, Ibrahim Danad
, Paul Knaapen^*

^*Corresponding author for this work

Vrije Universiteit Amsterdam
Department of Radiology, Ehime University Graduate School of Medicine, Ehime, Japan
Heartflow Inc.
Stanford University
New York Presbyterian Hospital
University of British Columbia
Ehime University Graduate School of Medicine

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: This study aimed to investigate the diagnostic value of comprehensive on-site coronary computed tomography angiography (CCTA) using stenosis and plaque measures and subtended myocardial mass (V _sub) for fractional flow reserve (FFR) defined hemodynamically obstructive coronary artery disease (CAD). Additionally, the incremental diagnostic value of off-site CT-derived FFR (FFR _CT) was assessed. Methods: Prospectively enrolled patients underwent CCTA followed by invasive FFR interrogation of all major coronary arteries. Vessels with ≥30% stenosis were included for analysis. On-site CCTA assessment included qualitative and quantitative stenosis (visual grading and minimal lumen area, MLA) and plaque measures (characteristics and volumes), and V _sub. Diagnostic value of comprehensive on-site CCTA assessment was tested by comparing area under the curves (AUC). In vessels with available FFR _CT, the incremental value of off-site FFR _CT was tested. Results: In 236 vessels (132 patients), MLA, positive remodeling, non-calcified plaque volume, and V _sub were independent on-site CCTA predictors for hemodynamically obstructive CAD (p < 0.05 for all). V _sub/MLA ² outperformed all these on-site CCTA parameters (AUC = 0.85) and V _sub was incremental to all other CCTA predictors (p = 0.02). In subgroup analysis (n = 194 vessels), diagnostic performance of FFR _CT and V _sub/MLA ² was similar (AUC 0.89 and 0.85 respectively, p = 0.25). Furthermore, diagnostic performance significantly albeit minimally increased when FFR _CT was added to on-site CCTA assessment (ΔAUC = 0.03, p = 0.02). Conclusions: In comprehensive on-site CCTA assessment, V _sub/MLA2 demonstrated greatest diagnostic value for hemodynamically obstructive CAD and V _sub was incremental to all evaluated CCTA indices. Additionally, adding FFR _CT only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to FFR _CT. Several novel indices have been proposed to increase the diagnostic performance of coronary computed tomography angiography (CCTA). The diagnostic value of comprehensive on-site CCTA assessment using qualitative and quantitative stenosis and plaque measures and subtended myocardial mass (V _sub) for fractional flow reserve (FFR) defined hemodynamically obstructive CAD was assessed in 236 vessels with ≥30% stenosis (132 patients). V _sub/MLA ² demonstrated greatest diagnostic value and V _sub was incremental to all evaluated CCTA indices. The addition of off-site CT-derived FFR (FFR _CT, in 192 vessels) only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to off-site assessment using FFR _CT.

Original language	English
Pages (from-to)	37-45
Number of pages	9
Journal	Journal of cardiovascular computed tomography
Volume	15
Issue number	1
Early online date	2020
DOIs	https://doi.org/10.1016/j.jcct.2020.05.002
Publication status	Published - 1 Jan 2021

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Coronary computed tomography angiogaphy
FFR
Fractional flow reserve
Subtended myocardial mass
V

Access to Document

10.1016/j.jcct.2020.05.002

Cite this

Bom, M. J., Driessen, R. S., Kurata, A., van Diemen, P. A., Everaars, H., Schumacher, S. P., de Winter, R. W., van de Ven, P. M., van Rossum, A. C., Taylor, C. A., Min, J. K., Leipsic, J. A., Danad, I., & Knaapen, P. (2021). Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease. Journal of cardiovascular computed tomography, 15(1), 37-45. https://doi.org/10.1016/j.jcct.2020.05.002

@article{23bf928ec9df4409adc5973c03edabde,

title = "Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease",

abstract = "Background: This study aimed to investigate the diagnostic value of comprehensive on-site coronary computed tomography angiography (CCTA) using stenosis and plaque measures and subtended myocardial mass (V sub) for fractional flow reserve (FFR) defined hemodynamically obstructive coronary artery disease (CAD). Additionally, the incremental diagnostic value of off-site CT-derived FFR (FFR CT) was assessed. Methods: Prospectively enrolled patients underwent CCTA followed by invasive FFR interrogation of all major coronary arteries. Vessels with ≥30\% stenosis were included for analysis. On-site CCTA assessment included qualitative and quantitative stenosis (visual grading and minimal lumen area, MLA) and plaque measures (characteristics and volumes), and V sub. Diagnostic value of comprehensive on-site CCTA assessment was tested by comparing area under the curves (AUC). In vessels with available FFR CT, the incremental value of off-site FFR CT was tested. Results: In 236 vessels (132 patients), MLA, positive remodeling, non-calcified plaque volume, and V sub were independent on-site CCTA predictors for hemodynamically obstructive CAD (p < 0.05 for all). V sub/MLA 2 outperformed all these on-site CCTA parameters (AUC = 0.85) and V sub was incremental to all other CCTA predictors (p = 0.02). In subgroup analysis (n = 194 vessels), diagnostic performance of FFR CT and V sub/MLA 2 was similar (AUC 0.89 and 0.85 respectively, p = 0.25). Furthermore, diagnostic performance significantly albeit minimally increased when FFR CT was added to on-site CCTA assessment (ΔAUC = 0.03, p = 0.02). Conclusions: In comprehensive on-site CCTA assessment, V sub/MLA2 demonstrated greatest diagnostic value for hemodynamically obstructive CAD and V sub was incremental to all evaluated CCTA indices. Additionally, adding FFR CT only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to FFR CT. Several novel indices have been proposed to increase the diagnostic performance of coronary computed tomography angiography (CCTA). The diagnostic value of comprehensive on-site CCTA assessment using qualitative and quantitative stenosis and plaque measures and subtended myocardial mass (V sub) for fractional flow reserve (FFR) defined hemodynamically obstructive CAD was assessed in 236 vessels with ≥30\% stenosis (132 patients). V sub/MLA 2 demonstrated greatest diagnostic value and V sub was incremental to all evaluated CCTA indices. The addition of off-site CT-derived FFR (FFR CT, in 192 vessels) only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to off-site assessment using FFR CT. ",

keywords = "Coronary computed tomography angiogaphy, FFR, Fractional flow reserve, Subtended myocardial mass, V",

author = "Bom, \{Michiel J.\} and Driessen, \{Roel S.\} and Akira Kurata and \{van Diemen\}, \{Pepijn A.\} and Henk Everaars and Schumacher, \{Stefan P.\} and \{de Winter\}, \{Ruben W.\} and \{van de Ven\}, \{Peter M.\} and \{van Rossum\}, \{Albert C.\} and Taylor, \{Charles A.\} and Min, \{James K.\} and Leipsic, \{Jonathon A.\} and Ibrahim Danad and Paul Knaapen",

year = "2021",

month = jan,

day = "1",

doi = "10.1016/j.jcct.2020.05.002",

language = "English",

volume = "15",

pages = "37--45",

journal = "Journal of cardiovascular computed tomography",

issn = "1934-5925",

publisher = "Elsevier Inc.",

number = "1",

}

Bom, MJ , Driessen, RS, Kurata, A, van Diemen, PA , Everaars, H, Schumacher, SP, de Winter, RW, van de Ven, PM, van Rossum, AC, Taylor, CA, Min, JK, Leipsic, JA, Danad, I & Knaapen, P 2021, 'Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease', Journal of cardiovascular computed tomography, vol. 15, no. 1, pp. 37-45. https://doi.org/10.1016/j.jcct.2020.05.002

Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease. / Bom, Michiel J.; Driessen, Roel S.; Kurata, Akira et al.
In: Journal of cardiovascular computed tomography, Vol. 15, No. 1, 01.01.2021, p. 37-45.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease

AU - Bom, Michiel J.

AU - Driessen, Roel S.

AU - Kurata, Akira

AU - van Diemen, Pepijn A.

AU - Everaars, Henk

AU - Schumacher, Stefan P.

AU - de Winter, Ruben W.

AU - van de Ven, Peter M.

AU - van Rossum, Albert C.

AU - Taylor, Charles A.

AU - Min, James K.

AU - Leipsic, Jonathon A.

AU - Danad, Ibrahim

AU - Knaapen, Paul

PY - 2021/1/1

Y1 - 2021/1/1

N2 - Background: This study aimed to investigate the diagnostic value of comprehensive on-site coronary computed tomography angiography (CCTA) using stenosis and plaque measures and subtended myocardial mass (V sub) for fractional flow reserve (FFR) defined hemodynamically obstructive coronary artery disease (CAD). Additionally, the incremental diagnostic value of off-site CT-derived FFR (FFR CT) was assessed. Methods: Prospectively enrolled patients underwent CCTA followed by invasive FFR interrogation of all major coronary arteries. Vessels with ≥30% stenosis were included for analysis. On-site CCTA assessment included qualitative and quantitative stenosis (visual grading and minimal lumen area, MLA) and plaque measures (characteristics and volumes), and V sub. Diagnostic value of comprehensive on-site CCTA assessment was tested by comparing area under the curves (AUC). In vessels with available FFR CT, the incremental value of off-site FFR CT was tested. Results: In 236 vessels (132 patients), MLA, positive remodeling, non-calcified plaque volume, and V sub were independent on-site CCTA predictors for hemodynamically obstructive CAD (p < 0.05 for all). V sub/MLA 2 outperformed all these on-site CCTA parameters (AUC = 0.85) and V sub was incremental to all other CCTA predictors (p = 0.02). In subgroup analysis (n = 194 vessels), diagnostic performance of FFR CT and V sub/MLA 2 was similar (AUC 0.89 and 0.85 respectively, p = 0.25). Furthermore, diagnostic performance significantly albeit minimally increased when FFR CT was added to on-site CCTA assessment (ΔAUC = 0.03, p = 0.02). Conclusions: In comprehensive on-site CCTA assessment, V sub/MLA2 demonstrated greatest diagnostic value for hemodynamically obstructive CAD and V sub was incremental to all evaluated CCTA indices. Additionally, adding FFR CT only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to FFR CT. Several novel indices have been proposed to increase the diagnostic performance of coronary computed tomography angiography (CCTA). The diagnostic value of comprehensive on-site CCTA assessment using qualitative and quantitative stenosis and plaque measures and subtended myocardial mass (V sub) for fractional flow reserve (FFR) defined hemodynamically obstructive CAD was assessed in 236 vessels with ≥30% stenosis (132 patients). V sub/MLA 2 demonstrated greatest diagnostic value and V sub was incremental to all evaluated CCTA indices. The addition of off-site CT-derived FFR (FFR CT, in 192 vessels) only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to off-site assessment using FFR CT.

AB - Background: This study aimed to investigate the diagnostic value of comprehensive on-site coronary computed tomography angiography (CCTA) using stenosis and plaque measures and subtended myocardial mass (V sub) for fractional flow reserve (FFR) defined hemodynamically obstructive coronary artery disease (CAD). Additionally, the incremental diagnostic value of off-site CT-derived FFR (FFR CT) was assessed. Methods: Prospectively enrolled patients underwent CCTA followed by invasive FFR interrogation of all major coronary arteries. Vessels with ≥30% stenosis were included for analysis. On-site CCTA assessment included qualitative and quantitative stenosis (visual grading and minimal lumen area, MLA) and plaque measures (characteristics and volumes), and V sub. Diagnostic value of comprehensive on-site CCTA assessment was tested by comparing area under the curves (AUC). In vessels with available FFR CT, the incremental value of off-site FFR CT was tested. Results: In 236 vessels (132 patients), MLA, positive remodeling, non-calcified plaque volume, and V sub were independent on-site CCTA predictors for hemodynamically obstructive CAD (p < 0.05 for all). V sub/MLA 2 outperformed all these on-site CCTA parameters (AUC = 0.85) and V sub was incremental to all other CCTA predictors (p = 0.02). In subgroup analysis (n = 194 vessels), diagnostic performance of FFR CT and V sub/MLA 2 was similar (AUC 0.89 and 0.85 respectively, p = 0.25). Furthermore, diagnostic performance significantly albeit minimally increased when FFR CT was added to on-site CCTA assessment (ΔAUC = 0.03, p = 0.02). Conclusions: In comprehensive on-site CCTA assessment, V sub/MLA2 demonstrated greatest diagnostic value for hemodynamically obstructive CAD and V sub was incremental to all evaluated CCTA indices. Additionally, adding FFR CT only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to FFR CT. Several novel indices have been proposed to increase the diagnostic performance of coronary computed tomography angiography (CCTA). The diagnostic value of comprehensive on-site CCTA assessment using qualitative and quantitative stenosis and plaque measures and subtended myocardial mass (V sub) for fractional flow reserve (FFR) defined hemodynamically obstructive CAD was assessed in 236 vessels with ≥30% stenosis (132 patients). V sub/MLA 2 demonstrated greatest diagnostic value and V sub was incremental to all evaluated CCTA indices. The addition of off-site CT-derived FFR (FFR CT, in 192 vessels) only minimally increased diagnostic performance, demonstrating that on-site CCTA assessment is a reasonable alternative to off-site assessment using FFR CT.

KW - Coronary computed tomography angiogaphy

KW - FFR

KW - Fractional flow reserve

KW - Subtended myocardial mass

KW - V

UR - https://www.scopus.com/pages/publications/85086573054

U2 - 10.1016/j.jcct.2020.05.002

DO - 10.1016/j.jcct.2020.05.002

M3 - Article

C2 - 32540206

SN - 1934-5925

VL - 15

SP - 37

EP - 45

JO - Journal of cardiovascular computed tomography

JF - Journal of cardiovascular computed tomography

IS - 1

ER -

Diagnostic value of comprehensive on-site and off-site coronary CT angiography for identifying hemodynamically obstructive coronary artery disease

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Cite this