The ASLA Score: A CT Angiographic Index to Predict Functionally Significant Coronary Stenoses in Lesions with Intermediate Severity—Diagnostic Accuracy

Ko, Brian; Wong, D.; Cameron, James D.; Leong, Darryl P.; Soh, Siang Yong; Nerlekar, Nitesh; Meredith, Ian T.; Seneviratne, Sujith

doi:10.1148/radiol.15141231

Cited by 16 publications

(17 citation statements)

References 28 publications

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“…Unfortunately, validation studies comparing TAG to invasive FFR values showed poor accuracy results (sensitivity: 58%; specificity: 86%; positive predictive value: 64% negative predictive value 83%) (93), with area under the curve values equal to the flip of a dime (AUC =0.50) (94). A more qualitative method is the area of stenosis, lesion length, and APPROACH (ASLA) score (95), which uses plaque burden, minimal luminal area and diameter, stenosis diameter, area of stenosis, lesion length, remodeling index, plaque morphology, calcification severity, and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score (96), which estimates the amount of myocardium at risk to identify hemodynamically significant lesions. Based on 85 patients, Ko et al demonstrated that the ALSA score was superior to area stenosis, lesion length and the APPROACH score in predicting significant FFR values (95).…”

Section: Stenosis Assessment With Coronary Ctamentioning

confidence: 99%

“…A more qualitative method is the area of stenosis, lesion length, and APPROACH (ASLA) score (95), which uses plaque burden, minimal luminal area and diameter, stenosis diameter, area of stenosis, lesion length, remodeling index, plaque morphology, calcification severity, and the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) score (96), which estimates the amount of myocardium at risk to identify hemodynamically significant lesions. Based on 85 patients, Ko et al demonstrated that the ALSA score was superior to area stenosis, lesion length and the APPROACH score in predicting significant FFR values (95). Another approach to evaluate hemodynamic relevance of coronary lesions is CT myocardial perfusion (97).…”

Section: Stenosis Assessment With Coronary Ctamentioning

confidence: 99%

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Plaque imaging with CT—a comprehensive review on coronary CT angiography based risk assessment

Kolossváry¹,

Szilveszter²,

Merkely³

et al. 2017

Cardiovasc. Diagn. Ther.

106

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CT based technologies have evolved considerably in recent years. Coronary CT angiography (CTA) provides robust assessment of coronary artery disease (CAD). Early coronary CTA imaging-as a gate-keeper of invasive angiography-has focused on the presence of obstructive stenosis. Coronary CTA is currently the only non-invasive imaging modality for the evaluation of non-obstructive CAD, which has been shown to contribute to adverse cardiac events. Importantly, improved spatial resolution of CT scanners and novel image reconstruction algorithms enable the quantification and characterization of atherosclerotic plaques. State-of-the-art CT imaging can therefore reliably assess the extent of CAD and differentiate between various plaque features. Recent studies have demonstrated the incremental prognostic value of adverse plaque features over luminal stenosis. Comprehensive coronary plaque assessment holds potential to significantly improve individual risk assessment incorporating adverse plaque characteristics, the extent and severity of atherosclerotic plaque burden. As a result, several coronary CTA based composite risk scores have been proposed recently to determine patients at high risk for adverse events. Coronary CTA became a promising modality for the evaluation of functional significance of coronary lesions using CT derived fractional flow reserve (FFR-CT) and/or rest/dynamic myocardial CT perfusion. This could lead to substantial reduction in unnecessary invasive catheterization procedures and provide information on ischemic burden of CAD. Discordance between the degree of stenosis and ischemia has been recognized in clinical landmark trials using invasive FFR. Both lesion stenosis and composition are possibly related to myocardial ischemia. The evaluation of lesion-specific ischemia using combined functional and morphological plaque information could ultimately improve the diagnostic performance of CTA and thus patient care. In this review we aimed to summarize current evidence on comprehensive coronary artery plaque assessment using coronary CTA.

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Section: Stenosis Assessment With Coronary Ctamentioning

confidence: 99%

Section: Stenosis Assessment With Coronary Ctamentioning

confidence: 99%

Plaque imaging with CT—a comprehensive review on coronary CT angiography based risk assessment

Kolossváry¹,

Szilveszter²,

Merkely³

et al. 2017

Cardiovasc. Diagn. Ther.

106

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“…In this study, only 33 vessels (31.73%) had hemodynamically relevant stenosis confirmed by invasive FFR measurements. It was in the range of the FFR positive percentage (28-44%) in recent reported studies based on CCTA and ICA [14][15][16][17][18][19], i.e., about two-thirds of FFR measurements finally have negative results. It is mainly contributed to the low sensitivity and PPV with 50% and 59%, respectively, when DS% of ≥ 70% was used as a cutoff value alone.…”

Section: Discussionmentioning

confidence: 69%

“…Similarly, the area of stenosis (AS %) was defined as 100 × (reference lumen − minimal lumen area)/reference lumen. Plaque load (PL) was defined as 100 × (outer vessel area − lumen area)/ outer vessel area and remodeling index (RI) as 100% × outer vessel area (stenotic segment)/outer vessel area (reference segment) [14].…”

Section: Anatomical Feature Measurement Using Cctamentioning

confidence: 99%

“…Besides stenosis severity, the amount of the myocardium in jeopardy is proved as another important factor that effects the FFR value of coronary lesions [13]. Numerous studies have confirmed that the diagnostic performance could be improved by taking into consideration the information about the amount of myocardium at risk, mostly based on ICA data [14][15][16][17][18], in which some different attempts has been used to estimate the myocardial volume perfused by stenotic coronary artery. Myocardial Jeopardy Index (MJI) is primary calculated based on the coronary size and the location in ICA images to estimate the percentage of the left ventricular myocardium subtended to a coronary lesion and has showed a modest correlation to FFR in invasive coronary angiography study [15].…”

Section: Introductionmentioning

confidence: 99%

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A comprehensive prediction model of functionally significant coronary artery stenosis based on coronary computed tomography and the amount of myocardium in jeopardy assessed by fractional flow reserve

Yang

Han

et al. 2019

Chin J Acad Radiol

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Objective To explore a method for estimating the amount of myocardium in jeopardy based on CCTA and derive a comprehensive prediction model for coronary lesions with fractional flow reserve (FFR) value of 0.8 or less. Materials and methods Quantitative features and Myocardial Jeopardy Index (MJI) were measured in 104 coronary arteries of 91 CCTA exams, retrospectively. For 80 left anterior descending (LAD) arteries, the sum of vessel score, diameter stenosis, proximal lesions, apical wrap, long disease, and bifurcation disease were evaluated. The multivariate logistic regression analysis was applied to identify independent predictors for FFR ≤ 0.8. A LAD-Score was then derived to predict the hemodynamic significance of LAD lesions. Results MJI, diameter stenosis and minimum lesion diameter were significant independent predictors for FFR ≤ 0.8 in all 104 vessels at multivariate analysis. The integrated diagnostic accuracy of multi-predictor was increased to 83% from 72% when using stenosis of 70% alone. The area under the receiver operating characteristic curve (AUC) was increased from 0.738 to 0.839 correspondingly. For LAD lesions, the optional cutoff value of stenosis was 62.5%, with a diagnostic accuracy of 71% and AUC of 0.746. Using LAD-Score, the diagnosis accuracy was improved to 84% with AUC of 0.874. Conclusion The MJI, estimated in CCTA, can help to predict the coronary lesion's hemodynamic significance more accurately. The LAD-Score, combining LAD lesion features and the amount of myocardium in jeopardy estimated in CCTA, improves the diagnostic performance assessed using invasive FFR.

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Integrated prediction of lesion-specific ischaemia from quantitative coronary CT angiography using machine learning: a multicentre study

et al. 2018

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The ASLA Score: A CT Angiographic Index to Predict Functionally Significant Coronary Stenoses in Lesions with Intermediate Severity—Diagnostic Accuracy

Abstract: The ASLA score, which accounts for CT-derived area of stenosis, lesion length, and APPROACH score, may conveniently improve the prediction, beyond individual indexes, of functionally significant intermediate coronary lesions.

Cited by 16 publications

References 28 publications

Plaque imaging with CT—a comprehensive review on coronary CT angiography based risk assessment

Plaque imaging with CT—a comprehensive review on coronary CT angiography based risk assessment

A comprehensive prediction model of functionally significant coronary artery stenosis based on coronary computed tomography and the amount of myocardium in jeopardy assessed by fractional flow reserve

Integrated prediction of lesion-specific ischaemia from quantitative coronary CT angiography using machine learning: a multicentre study

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