Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA)

Marta Belmonte; Pasquale Paolisso; Emanuele Gallinoro; Dario Tino Bertolone; Attilio Leone; Giuseppe Esposito; Serena Caglioni; Michele Mattia Viscusi; Konstantinos Bermpeis; Tatyana Storozhenko; Eric Wyffels; Joseph Bartunek; Jeroen Sonck; Carlos Collet; Daniele Andreini; Marc Vanderheyden; Martin Penicka; Emanuele Barbato

doi:10.1016/j.jcct.2024.09.015

Improved diagnostic accuracy of vessel-specific myocardial ischemia by coronary computed tomography angiography (CCTA)

J Cardiovasc Comput Tomogr. 2024 Oct 9:S1934-5925(24)00449-0. doi: 10.1016/j.jcct.2024.09.015. Online ahead of print.

Authors

Marta Belmonte¹, Pasquale Paolisso², Emanuele Gallinoro², Dario Tino Bertolone¹, Attilio Leone¹, Giuseppe Esposito³, Serena Caglioni⁴, Michele Mattia Viscusi¹, Konstantinos Bermpeis⁵, Tatyana Storozhenko⁵, Eric Wyffels⁵, Joseph Bartunek⁵, Jeroen Sonck⁵, Carlos Collet⁵, Daniele Andreini⁶, Marc Vanderheyden⁵, Martin Penicka⁷, Emanuele Barbato⁸

Affiliations

¹ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
² Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; IRCCS Galeazzi Sant'Ambrogio Hospital, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
³ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Interventional Cardiology Unit, De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy.
⁴ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Unit, Azienda Ospedaliero Universitaria Di Ferrara, Cona, Ferrara, Italy.
⁵ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
⁶ IRCCS Galeazzi Sant'Ambrogio Hospital, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
⁷ Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium. Electronic address: martin.penicka@olvz-aalst.be.
⁸ Department of Clinical and Molecular Medicine, Sapienza University of Rome, Roma, Italy. Electronic address: emanuele.barbato@uniroma1.it.

PMID: 39389894
DOI: 10.1016/j.jcct.2024.09.015

Abstract

Background: Discrepancies between stenosis severity assessed at coronary computed tomography angiography (CCTA) and ischemia might depend on vessel type. Coronary plaque features are associated with ischemia. Thus, we evaluated the vessel-specific correlation of CCTA-derived diameter stenosis (DS) and invasive fractional flow reserve (FFR) and explored whether integrating morphological plaque features stratified by vessel might increase the predictive yield in identifying vessel-specific ischemia.

Methods: Observational cohort study including patients undergoing CCTA for suspected coronary artery disease, with at least one vessel with DS ≥ 50 % at CCTA, undergoing invasive coronary angiography and FFR. Plaque analysis was performed using validated semi-automated software. Coronary vessels were stratified in left anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA). Per vessel independent predictors of ischemia among CCTA-derived anatomical and morphologic plaque features were tested at univariable and multivariable logistic regression analysis. The best cut-off to predict ischemia was determined by Youden's index. Ischemia was defined by FFR≤0.80.

Results: The study population consisted of 192 patients, of whom 224 vessels (61 % LAD, 19 % LCX, 20 % RCA) had lesions with DS ≥ 50 % interrogated by FFR. Despite similar DS, the rate of FFR≤0.80 was higher in the LAD compared to LCX and RCA (67.2 % vs 43.2 % and 44.2 %, respectively, p = 0.018). A significant correlation between DS and FFR was observed only in LAD (p = 0.003). At multivariable analysis stratified by vessel, the vessel-specific independent predictors of positive FFR were percent atheroma volume (threshold>17 %) for LAD, non-calcified plaque volume (threshold >130 mm³) for LCX, and lumen volume (threshold <844 mm³) for RCA. Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for ischemia compared to DS alone (AUC ranging from 0.51 to 0.63 to 0.76-0.80).

Conclusions: Integrating DS and vessel-specific morphological plaque features significantly increased the predictive yield for vessel-specific ischemia compared to DS alone, potentially improving patients' referral to the catheterization laboratory.

Keywords: Coronary computed tomography angiography; Fractional flow reserve; Ischemia; Percent atheroma volume; Plaque analysis; Vessel.