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Effect of Plaque Burden and Morphology on Myocardial Blood Flow and Fractional Flow Reserve
- Source :
- Journal of the American College of Cardiology, 71, 499-509, Journal of the American College of Cardiology, 71, 5, pp. 499-509, Journal of the American College of Cardiology, 71(5), 499-509. Elsevier USA, Driessen, R S, Stuijfzand, W J, Raijmakers, P G, Danad, I, Min, J K, Leipsic, J A, Ahmadi, A, Narula, J, van de Ven, P M, Huisman, M C, Lammertsma, A A, van Rossum, A C, van Royen, N & Knaapen, P 2018, ' Effect of Plaque Burden and Morphology on Myocardial Blood Flow and Fractional Flow Reserve ', Journal of the American College of Cardiology, vol. 71, no. 5, pp. 499-509 . https://doi.org/10.1016/j.jacc.2017.11.054
- Publication Year :
- 2018
-
Abstract
- Background: Atherosclerotic plaque characteristics may affect downstream myocardial perfusion, as well as coronary lesion severity. Objectives: This study sought to evaluate the association between quantitative plaque burden and plaque morphology obtained using coronary computed tomography angiography (CTA) and quantitative myocardial perfusion obtained using [15O]H2O positron emission tomography (PET), as well as fractional flow reserve (FFR) derived invasively. Methods: Two hundred eight patients (63% men; age 58 ± 8.7 years) with suspected coronary artery disease were prospectively included. All patients underwent 256-slice coronary CTA, [15O]H2O PET, and invasive FFR measurements. Coronary CTA-derived plaque burden and morphology were assessed using commercially available software and compared with PET perfusion and FFR. Results: Atherosclerotic plaques were present in 179 patients (86%) and 415 of 610 (68%) evaluable coronary arteries. On a per-vessel basis, traditional coronary plaque burden indexes, such as plaque length and volume, minimal lumen area, and stenosis percentage, were significantly associated with impaired hyperemic myocardial blood flow (MBF) and FFR. In addition, morphological features, such as partially calcified plaques, positive remodeling (PR), and low attenuation plaque, displayed a negative impact on hyperemic MBF and FFR. Multivariable analysis revealed that the morphological feature of PR was independently related to impaired hyperemic MBF as well as an unfavorable FFR (p = 0.004 and p = 0.007, respectively), next to stenosis percentage (p = 0.001 and p < 0.001, respectively) and noncalcified plaque volume (p < 0.001 and p = 0.010, respectively). Conclusions: PR and noncalcified plaque volume are associated with detrimental downstream hyperemic myocardial perfusion and FFR, independent of lesion severity.
- Subjects :
- Male
medicine.medical_specialty
Lumen (anatomy)
Coronary Artery Disease
Fractional flow reserve
030204 cardiovascular system & hematology
Coronary Angiography
Lesion
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Predictive Value of Tests
Internal medicine
medicine
Humans
Prospective Studies
030212 general & internal medicine
Aged
business.industry
Myocardial Perfusion Imaging
Vascular damage Radboud Institute for Molecular Life Sciences [Radboudumc 16]
Blood flow
Middle Aged
medicine.disease
Plaque, Atherosclerotic
Fractional Flow Reserve, Myocardial
Coronary arteries
Stenosis
medicine.anatomical_structure
Positron-Emission Tomography
Cardiology
Female
medicine.symptom
Tomography, X-Ray Computed
Cardiology and Cardiovascular Medicine
business
Perfusion
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 71
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....04d02263cc29772c2c7971e0c38dc347