Ischemic Myocardial Burden Subtended by Computed Tomography–Derived Fractional Flow Reserve (APPROACHFFRCT)

Ihdayhid, Abdul Rahman; Nørgaard, Bjarne Linde; Achenbach, Stephan; Khav, Nancy; Gaur, Sara; Leipsic, Jonathan; Nerlekar, Nitesh; Osawa, Kazuhiro; Miyoshi, Toru; Jensen, Jesper Møller; Kimura, Takeshi; Shiomi, Hiroki; Ērglis, Andrejs; Oldroyd, Keith G.; Bøtker, Hans Erik; Narula, Jagat; Ko, Brian

doi:10.1016/j.jcmg.2020.05.008

Cited by 7 publications

(9 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The repeated CTA + FFR CT investigation strategy in the FLOWPROMOTE study allows for comprehensive assessment of the temporal interplay between lipid lowering therapy, changes in disease morphology and physiology including new metrics such as PCAT attenuation, V/M ratio and the APPROACH FFRCT score. 25 , 30 , 31 …”

Section: Discussionmentioning

confidence: 99%

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Mortensen

Sand²,

Busk

et al. 2022

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Introduction Coronary CT angiography (CTA) derived fractional flow reserve (FFR CT ) shows high diagnostic performance when compared to invasively measured FFR. Presence and extent of low attenuation plaque density have been shown to be associated with abnormal physiology by measured FFR. Moreover, it is well established that statin therapy reduces the rate of plaque progression and results in morphology alterations underlying atherosclerosis. However, the interplay between lipid lowering treatment, plaque regression, and the coronary physiology has not previously been investigated. Aim To test whether lipid lowering therapy is associated with significant improvement in FFR CT , and whether there is a dose–response relationship between lipid lowering intensity, plaque regression, and coronary flow recovery. Methods Investigator driven, prospective, multicenter, randomized study of patients with stable angina, coronary stenosis ≥50% determined by clinically indicated first‐line CTA, and FFR CT ≤ 0.80 in whom coronary revascularization was deferred. Patients are randomized to standard (atorvastatin 40 mg daily) or intensive (rosuvastatin 40 mg + ezetimibe 10 mg daily) lipid lowering therapy for 18 months. Coronary CTA scans with blinded coronary plaque and FFR CT analyses will be repeated after 9 and 18 months. The primary endpoint is the 18‐month difference in FFR CT using (1) the FFR CT value 2 cm distal to stenosis and (2) the lowest distal value in the vessel of interest. A total of 104 patients will be included in the study. Conclusion The results of this study will provide novel insights into the interplay between lipid lowering, and the pathophysiology in coronary artery disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Mortensen

Sand²,

Busk

et al. 2022

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“… 27 28 The present study confirms in a large dataset previous findings demonstrating an FFR CT risk continuum, with lower values being associated with higher risk. 17 19 23 The integration of an FFR CT continuous interpretation strategy with emerging CTA-derived metrics such as quantification of high-risk plaques, 29 haemodynamic plaque forces 30 and the ischaemic myocardium 31 may potentially allow for a more individualised CTA ‘one-stop-shop’ platform for guiding therapeutic decision-making and for predicting clinical outcomes. 27 More studies are needed to elucidate the risk/benefit trade-offs of a continuous versus a dichotomous FFR CT interpretation strategy in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis

Nørgaard

Gaur

Fairbairn

et al. 2021

Heart

Self Cite

View full text Add to dashboard Cite

ObjectivesTo obtain more powerful assessment of the prognostic value of fractional flow reserveCT testing we performed a systematic literature review and collaborative meta-analysis of studies that assessed clinical outcomes of CT-derived calculation of FFR (FFRCT) (HeartFlow) analysis in patients with stable coronary artery disease (CAD).MethodsWe searched PubMed and Web of Science electronic databases for published studies that evaluated clinical outcomes following fractional flow reserveCT testing between 1 January 2010 and 31 December 2020. The primary endpoint was defined as ‘all-cause mortality (ACM) or myocardial infarction (MI)’ at 12-month follow-up. Exploratory analyses were performed using major adverse cardiovascular events (MACEs, ACM+MI+unplanned revascularisation), ACM, MI, spontaneous MI or unplanned (>3 months) revascularisation as the endpoint.ResultsFive studies were identified including a total of 5460 patients eligible for meta-analyses. The primary endpoint occurred in 60 (1.1%) patients, 0.6% (13/2126) with FFRCT>0.80% and 1.4% (47/3334) with FFRCT ≤0.80 (relative risk (RR) 2.31 (95% CI 1.29 to 4.13), p=0.005). Likewise, MACE, MI, spontaneous MI or unplanned revascularisation occurred more frequently in patients with FFRCT ≤0.80 versus patients with FFRCT >0.80. Each 0.10-unit FFRCT reduction was associated with a greater risk of the primary endpoint (RR 1.67 (95% CI 1.47 to 1.87), p<0.001).ConclusionsThe 12-month outcomes in patients with stable CAD show low rates of events in those with a negative FFRCT result, and lower risk of an unfavourable outcome in patients with a negative test result compared with patients with a positive test result. Moreover, the FFRCT numerical value was inversely associated with outcomes.

show abstract

“…Second, ΔFFR CT was defined by computing the difference in FFR CT values at the proximal and distal sites of each lesion. Third, the percent ischemic myocardial mass of each vessel segment was defined as the ratio between the myocardial mass subtended beyond the point at which the vessel's FFR CT is ≤0.80 and the entire vessel segment ( 14 ). Myocardial mass was computed using a stem-and-crown model ( 15 , 16 ), which is based on allometric scaling between the length of the coronary arterial tree and myocardial mass ( 15 , 16 ).…”

Section: Methodsmentioning

confidence: 99%

Anatomic and Hemodynamic Plaque Characteristics for Subsequent Coronary Events

Lee

Hong

Shin

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

ObjectivesWhile coronary computed tomography angiography (CCTA) enables the evaluation of anatomic and hemodynamic plaque characteristics of coronary artery disease (CAD), the clinical roles of these characteristics are not clear. We sought to evaluate the prognostic implications of CCTA-derived anatomic and hemodynamic plaque characteristics in the prediction of subsequent coronary events.MethodsThe study cohort consisted of 158 patients who underwent CCTA with suspected CAD within 6–36 months before percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) or unstable angina and age-/sex-matched 62 patients without PCI as the control group. Preexisting high-risk plaque characteristics (HRPCs: low attenuation plaque, positive remodeling, napkin-ring sign, spotty calcification, minimal luminal area <4 mm2, or plaque burden ≥70%) and hemodynamic parameters (per-vessel fractional flow reserve [FFRCT], per-lesion ΔFFRCT, and percent ischemic myocardial mass) were analyzed from prior CCTA. The primary outcome was a subsequent coronary event, which was defined as a composite of vessel-specific MI or revascularization for unstable angina. The prognostic impact of clinical risk factors, HRPCs, and hemodynamic parameters were compared between vessels with (160 vessels) and without subsequent coronary events (329 vessels).ResultsVessels with a subsequent coronary event had higher number of HRPCs (2.6 ± 1.4 vs. 2.3 ± 1.4, P = 0.012), lower FFRCT (0.76 ± 0.13 vs. 0.82 ± 0.11, P < 0.001), higher ΔFFRCT (0.14 ± 0.12 vs. 0.09 ± 0.08, P < 0.001), and higher percent ischemic myocardial mass (29.0 ± 18.5 vs. 26.0 ± 18.4, P = 0.022) than those without a subsequent coronary event. Compared with clinical risk factors, HRPCs and hemodynamic parameters showed higher discriminant abilities for subsequent coronary events with ΔFFRCT being the most powerful predictor. HRPCs showed additive discriminant ability to clinical risk factors (c-index 0.620 vs. 0.558, P = 0.027), and hemodynamic parameters further increased discriminant ability (c-index 0.698 vs. 0.620, P = 0.001) and reclassification abilities (NRI 0.460, IDI 0.061, P < 0.001 for all) for subsequent coronary events. Among vessels with negative FFRCT (>0.80), adding HRPCs into clinical risk factors significantly increased discriminant and reclassification abilities for subsequent coronary events (c-index 0.687 vs. 0.576, P = 0.005; NRI 0.412, P = 0.002; IDI 0.064, P = 0.001) but not for vessels with positive FFRCT (≤0.80).ConclusionIn predicting subsequent coronary events, both HRPCs and hemodynamic parameters by CCTA allow better prediction of subsequent coronary events than clinical risk factors. HRPCs provide more incremental predictability than clinical risk factors alone among vessels with negative FFRCT but not among vessels with positive FFRCT.Clinical Trial RegistrationPreDiction and Validation of Clinical CoursE of Coronary Artery DiSease With CT-Derived Non-INvasive HemodYnamic Phenotyping and Plaque Characterization (DESTINY Study), NCT04794868.

show abstract

Ischemic Myocardial Burden Subtended by Computed Tomography–Derived Fractional Flow Reserve (APPROACHFFRCT)

Cited by 7 publications

References 5 publications

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Influence of intensive lipid‐lowering on CT derived fractional flow reserve in patients with stable chest pain: Rationale and design of the FLOWPROMOTE study

Prognostic value of coronary computed tomography angiographic derived fractional flow reserve: a systematic review and meta-analysis

Anatomic and Hemodynamic Plaque Characteristics for Subsequent Coronary Events

Contact Info

Product

Resources

About