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The present study aimed to investigate the association between perivascular fat attenuation index (FAI), high-risk plaque features and serum level of high sensitive C-reactive protein (hs-CRP). Consecutive patients with intermediate pre-test probability of CAD, who were referred for coronary CT angiography (CCTA), were included. High-risk plaque features were assessed by CCTA and included low attenuation plaque (LAP), positive remodeling (PR), napkin-ring sign (NRS) and spotty calcification. Lesion specific perivascular FAI was also measured for all plaques located on major epicardial vessels with diameter ≧ 2 mm. Laboratory test results, including hs-CRP, were recorded. 199 patients with 260 lesions were finally included. NRS and LAP were more commonly present in the group with elevated hs-CRP (35.9% vs. 19.4% and 14.1% vs. 2.6%, both p < 0.05) and more severe stenosis extent was also noted for this group. However, there was no significant difference between the elevated hs-CRP and normal hs-CRP group with respect to other CT parameters, such as lesion length, PR, spotty calcification and focal calcium score. Perivascular FAI failed to show significant difference between the two groups (- 69.8 ± 10.3HU vs. - 70.0 ± 12.0HU, p = 0.953) and there was poor correlation between perivascular FAI and hs-CRP measurements (r =  - 0.04, p = 0.510). In conclusion, LAP and NRS are more commonly present in CAD patients with elevated level of hs-CRP. However, perivascular FAI failed to show such correlation with serum level of hs-CRP.

Aims: To study the diagnostic performance of the ratio of Duke jeopardy score (DJS) to the minimal lumen diameter (MLD) at coronary computed tomographic angiography (CCTA) and machine learning based CT-FFR for differentiating functionally significant from insignificant lesions, with reference to fractional flow reserve (FFR)., Methods and Results: Patients who underwent both coronary CTA and FFR measurement at invasive coronary angiography (ICA) within 2 weeks were retrospectively included in our study. CT-FFR, DJS/MLD CT ratio, along with other parameters, including minimal luminal area (MLA), MLD, lesion length (LL), diameter stenosis, area stenosis, plaque burden, and remodeling index of lesions, were recorded. Lesions with FFR ≤0.8 were considered to be functionally significant. One hundred and twenty-nine patients with 166 lesions were ultimately included for analysis. The LL, diameter stenosis, area stenosis, plaque burden, DJS and DJS/MLD CT ratio were all significantly longer or larger in the group of FFR ≤ 0.8 (p < 0.001 for all), while smaller MLA, MLD and CT-FFR value were also noted (p < 0.001 for all). CT-FFR and DJS/MLD CT ratio showed the largest AUC among all single parameters (AUC = 0.85 and AUC = 0.83, respectively; p < 0.001 for both) for diagnosing functionally significant stenosis. Combining CT-FFR and DJS/MLD CT ratio provided incremental value for discrimination between flow-limiting and non-flow-limiting coronary lesions and yielded the best diagnostic performance (accuracy of 83.7%)., Conclusions: The combination of ML-based CT-FFR and DJS/MLD CT allows accurate non-invasive discrimination between flow-limiting and non-flow-limiting coronary lesions., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To study the diagnostic performance of the ratio between the Duke jeopardy score (DJS) and the minimal lumen diameter (MLD) (DJS/MLD CT ratio) as assessed by coronary computed tomographic angiography (CTA) for differentiating functionally significant from non-significant coronary artery stenoses, with reference to invasive fractional flow reserve (FFR)., Methods: Patients who underwent both coronary CTA and FFR measurement during invasive coronary angiography (ICA) within 2 weeks were retrospectively included in the study. Invasive FFR measurement was performed in patients with intermediate to severe coronary stenoseis. DJS/MLD CT ratio and anatomical parameters were recorded. Lesions with FFR ≤0.80 were considered to be functionally significant., Results: One hundred and sixty-one patients with 175 lesions were included into the analysis. Diameter stenosis in CT, area stenosis, plaque burden, lesion length (LL), ICA-based stenosis degree, DJS, LL/MLD 4 ratio, DJS/MLA ratio as well as DJS/MLD ratio were all significantly different between hemodynamically significant and non-significant lesions (p<0.05 for all). ROC curve analysis determined the optimal cut-off value for DJS/MLD CT ratio to be 1.96 (area under curve = 0.863, 95 % confidence interval = 0.803-0.910), yielding a high diagnostic accuracy (86.9%, 152/175)., Conclusions: In coronary artery stenoses detected by coronary CTA, the DJS/MLD ratio is able to predict hemodynamic relevance., (Copyright © 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the diagnostic performance of the calcification remodeling index (RI) as assessed by coronary computed tomography angiography (coronary CTA) to predict the presence of severe coronary stenosis in atherosclerotic coronary lesions with moderate to severe calcification., Methods: Patients who underwent coronary CTA and invasive coronary angiography (ICA) within one month and had moderately to severely calcified lesions as revealed by coronary CTA, were retrospectively included. The calcification RI was calculated as the ratio of the cross-sectional lumen area (with inclusion of calcium area) of the most severely calcified site to the proximal reference lumen area. Other parameters, such as the calcium volume, regional Agatston score, calcification length, involved calcium arc quadrants and CTA-assessed diameter stenosis, were also recorded. A multivariate model was used to identify the variables that predict the presence of severe coronary stenosis (diameter stenosis ≧ 70%) as determined by ICA., Results: 422 patients with 629 lesions were finally included in the study. Lesions with severe stenoses as determined by ICA tended to have larger calcium volumes, regional Agatston scores, CTA-assessed diameter stenoses, longer calcium length, more involved calcium arc quadrants and a significantly smaller calcification remodeling index. ROC curve analysis determined the best cutoff value of the calcification RI as 0.94 (AUC = 0.816, p < 0.001), which yielded highest diagnostic accuracy (83.3%, 524/629) to identify severe coronary stenosis. Among all parameters, calcification RI ≦0.94 is the strongest independent predictor (odds ratio: 17.5, p < 0.001) of severe coronary stenosis., Conclusions: With an optimalcut-off value of 0.94, calcification RI is the strongest independent predictor of severe coronary stenosis in calcified coronary atherosclerotic lesions., (Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Objectives: To investigate the morphologic characteristics of early and late stages of chronic total coronary artery occlusions (CTO) in coronary computed tomography angiography (coronary CTA)., Methods: We retrospectively analyzed patients who underwent coronary CTA and invasive coronary angiography and had at least one CTO with known duration. The following parameters were obtained in coronary CTA: calcification of the occluded segment; stump morphology; lesion length; remodeling index; presence of intra-occlusion linear contrast enhancement; and density of non-calcified CTO components. CT parameters were compared between patients with early (duration ≤ 12 months) and late (duration > 12 months) stage CTO., Results: One-hundred and twelve patients with 124 chronically occluded coronary arteries were analyzed. Fifty nine patients had early stage CTOs (62 lesions) and 53 patients had late stage CTOs (62 lesions). Calcification was more severe in late-stage versus early CTOs (Agatston score: early stage, 27.4 ± 46.7 vs. late stage, 58.3 ± 112.4; p = 0.049). Remodeling index was lower in late-stage CTOs (early stage, 0.96 ± 0.2 vs. late stage, 0.88 ± 0.22; p = 0.034). In patients with late stage CTO, the presence of intra-occlusion linear enhancement was more likely (45.2% vs 14.5%, p < 0.001), and the density of non-calcified components was significantly higher (85.4 ± 27.2 HU vs. 65.7 ± 30.1 HU, p < 0.001). Stump morphology was not different between the two groups., Conclusions: Coronary CTA reveals differences between chronic total coronary occlusions of longer and shorter duration. A long duration is associated with focal calcification and negative remodeling, as well as intra-occlusion enhancement and a higher density of non-calcified components., (Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Objectives: The present study aimed to compare the diagnostic performance of a machine learning (ML)-based FFRCT algorithm, quantified subtended myocardial volume, and high-risk plaque features for predicting if a coronary stenosis is hemodynamically significant, with reference to FFRICA.Methods: Patients who underwent both CCTA and FFRICA measurement within 2 weeks were retrospectively included. ML-based FFRCT, volume of subtended myocardium (Vsub), percentage of subtended myocardium volume versus total myocardium volume (Vratio), high-risk plaque features, minimal lumen diameter (MLD), and minimal lumen area (MLA) along with other parameters were recorded. Lesions with FFRICA ≤ 0.8 were considered to be functionally significant.Results: One hundred eighty patients with 208 lesions were included. The lesion length (LL), diameter stenosis, area stenosis, plaque burden, Vsub, Vratio, Vratio/MLD, Vratio/MLA, and LL/MLD4 were all significantly longer or larger in the group of FFRICA ≤ 0.8 while smaller minimal lumen area, MLD, and FFRCT value were noted. The AUC of FFRCT + Vratio/MLD was significantly better than that of FFRCT alone (0.935 versus 0.873, p < 0.001). High-risk plaque features failed to show difference between functionally significant and insignificant groups. Vratio/MLD-complemented ML-based FFRCT for "gray zone" lesions with FFRCT value ranged from 0.7 to 0.8 and the combined use of these two parameters yielded the best diagnostic performance (86.5%, 180/208).Conclusions: ML-based FFRCT simulation and Vratio/MLD both provide incremental value over CCTA-derived diameter stenosis and high-risk plaque features for predicting hemodynamically significant lesions. Vratio/MLD is more accurate than ML-based FFRCT for lesions with simulated FFRCT value from 0.7 to 0.8.Key Points: • Machine learning-based FFR CT and subtended myocardium volume both performed well for predicting hemodynamically significant coronary stenosis. • Subtended myocardium volume was more accurate than machine learning-based FFR CT for "gray zone" lesions with simulated FFR value from 0.7 to 0.8. • CT-derived high-risk plaque features failed to correctly identify hemodynamically significant stenosis. [ABSTRACT FROM AUTHOR]

Aims To investigate the quantitative baseline CT plaque characterization of unrevascularized non-culprit intermediate coronary stenosis and its association with lesion volume progression and long-term prognosis. Methods Patients with baseline coronary CT angiography (CCTA) and invasive coronary angiography (ICA) and at least one unrevascularized non-culprit intermediate coronary stenosis were prospectively enrolled for this study. All patients were followed up by a second CCTA at 1-year to 1.5-year interval. High-risk plaque features as well as other quantitative plaque measurements were recorded. Results 140 patients with 165 unrevascularized non-culprit intermediate lesions were selected. Lesion volume progression was identified in 18 lesions (10.9%, 18/165) at follow-up CCTA and 15 patients experienced major adverse cardiac events (MACE) during a mean follow-up period of 51.5 months. Low attenuation plaque (LAP) was more frequently present in the lesion-progression subgroup and MACE subgroup (lesion-progression VS. non-lesion progression: 55.6% VS. 8.8% and MACE VS. MACE free: 40% VS. 12.8%, both p  < 0.05), while other parameters showed no significant differences. Based on stepwise multivariable logistic regression analysis, LAP was an independent predictor (OR = 16.74, 95%CI = 5.02 to 55.84, p  < 0.001) for lesion volume progression and MACE (OR = 4.25, 95%CI = 1.03 to 17.53, p  = 0.046). Conclusions The presence of LAP of unrevascularized non-culprit intermediate stenosis is associated with lesion volume progression and an independent predictor for MACE occurrence. [ABSTRACT FROM AUTHOR]