Diffuse coronary artery disease among other atherosclerotic plaque characteristics by coronary computed tomography angiography for predicting coronary vessel-specific ischemia by fractional flow reserve

Asim Rizvi, Bríain Hartaigh, Ibrahim Danad, Donghee Han, Ji Hyun Lee, Heidi Gransar, Jackie Szymonifka, Fay Y. Lin, James K. Min

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Background and aims Coronary computed tomography angiography (CCTA) permits effective identification of diffuse CAD and atherosclerotic plaque characteristics (APCs). We sought to examine the usefulness of diffuse CAD beyond luminal narrowing and APCs by CCTA to detect vessel-specific ischemia. Methods 407 vessels (n = 252 patients) from the DeFACTO diagnostic accuracy study were retrospectively analyzed for percent plaque diffuseness (PD). Percent plaque diffuseness (PD) was obtained on per-vessel level by summation of all contiguous lesion lengths and divided by total vessel length, and was logarithmically transformed (log percent PD). Additional CCTA measures of stenosis severity including minimal lumen diameter (MLD), and APCs, such as positive remodeling (PR) and low attenuation plaque (LAP), were also included. Vessel-specific ischemia was defined as fractional flow reserve (FFR) ≤0.80. Multivariable regression, discrimination by area under the receiver operating characteristic curve (AUC), and category-free net reclassification improvement (cNRI) were assessed. Results Backward stepwise logistic regression revealed that for every unit increase in log percent PD, there was a 58% (95% CI: 1.01–2.48, p = 0.048) rise in the odds of having an abnormal FFR, independent of stenosis severity and APCs. The AUC indicated no further improvement in discriminatory ability after adding log percent PD to the final parsimonious model of MLD, PR, and LAP (AUC difference: 0.003, 95% CI: −0.003–0.010, p = 0.33). Conversely, adding log percent PD to the base model of MLD, PR, and LAP improved cNRI by 0.21 (95% CI: 0.01–0.41, p < 0.001). Conclusions Accounting for diffuse CAD may help improve the accuracy of CCTA for detecting vessel-specific ischemia.

Original languageEnglish (US)
Pages (from-to)145-151
Number of pages7
JournalAtherosclerosis
Volume258
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

Keywords

  • Atherosclerotic plaque characteristics
  • Coronary computed tomography angiography
  • Diffuse coronary artery disease
  • Fractional flow reserve
  • Stenosis severity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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