Coronary CT angiography derived FFR in patients with left main disease

Katharina A Riedl; Jesper M Jensen; Brian S Ko; Jonathon Leipsic; Erik L Grove; Ole N Mathiassen; Hans Erik Bøtker; Bjarne L Nørgaard

doi:10.1007/s10554-021-02371-4

Coronary CT angiography derived FFR in patients with left main disease

Katharina A Riedl^*, Jesper M Jensen, Brian S Ko, Jonathon Leipsic, Erik L Grove, Ole N Mathiassen, Hans Erik Bøtker, Bjarne L Nørgaard

^*Corresponding author for this work

Department of Clinical Medicine - The Department of Cardiological Medicine B

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

The presence of left main coronary artery disease (LMCAD) is associated with an unfavorable clinical outcome. The clinical utility of FFRCT testing for non-invasive physiological assessment in LMCAD remains largely unknown. In this single center observational study LMCAD patients were retrospectively identified between November 2015 and December 2017. We evaluated the relationship between LMCAD diameter stenosis and downstream FFRCT values, and the clinical consequences following FFRCT testing in patients with LMCAD. The composite endpoint (all-cause death, myocardial infarction, unplanned revascularization) was determined over a median follow-up of 1.1 years. LMCAD was registered in 432 of 3202 (13%) patients having coronary CTA. FFRCT was prescribed in 213 (49%), while 59 (14%) patients were referred directly to invasive angiography or myocardial perfusion imaging. FFRCT was performed in 195 (45%) patients. LM stenosis severity was inversely related to downstream FFRCT values. In patients with simple LMCAD with stenosis ≥ 50%, > 80% had FFRCT > 0.80 in non-diseased proximal and downstream segments (n = 7). No patients with simple LMCAD and FFRCT > 0.80 (n = 20) suffered an adverse clinical outcome. FFRCT testing in patients with LMCAD is feasible. LM stenosis severity is inversely related to FFRCT value. Patients with LMCAD and FFRCT > 0.80 have favorable clinical outcomes at short-term follow-up. Large-scale studies assessing the clinical utility and safety of deferring invasive catheterization following FFRCT testing in patients with LMCAD are warranted.

Original language	English
Journal	The International Journal of Cardiovascular Imaging
Volume	37
Issue	11
Pages (from-to)	3299-3308
Number of pages	10
ISSN	1569-5794
DOIs	https://doi.org/10.1007/s10554-021-02371-4
Publication status	Published - Nov 2021

Keywords

Computed tomography angiography
Coronary angiography
Coronary artery disease
Fractional flow reserve
Left main
FRACTIONAL FLOW RESERVE
STENOSIS
PERFORMANCE
GUIDELINES
COMPUTED-TOMOGRAPHY ANGIOGRAPHY
SOCIETY
IMPACT
INTRAVASCULAR ULTRASOUND
OUTCOMES
ARTERY-DISEASE
Predictive Value of Tests
Humans
Tomography, X-Ray Computed
Coronary Stenosis/diagnostic imaging
Retrospective Studies
Severity of Illness Index
Computed Tomography Angiography
Coronary Artery Disease/diagnostic imaging
Coronary Angiography
Fractional Flow Reserve, Myocardial
Coronary Vessels/diagnostic imaging

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Riedl2021_Article_CoronaryCTAngiographyDerivedFFFinal published version, 1.04 MBLicence: CC BY

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@article{d45d18f51db9409fa8ef52db334606b3,

title = "Coronary CT angiography derived FFR in patients with left main disease",

abstract = "The presence of left main coronary artery disease (LMCAD) is associated with an unfavorable clinical outcome. The clinical utility of FFRCT testing for non-invasive physiological assessment in LMCAD remains largely unknown. In this single center observational study LMCAD patients were retrospectively identified between November 2015 and December 2017. We evaluated the relationship between LMCAD diameter stenosis and downstream FFRCT values, and the clinical consequences following FFRCT testing in patients with LMCAD. The composite endpoint (all-cause death, myocardial infarction, unplanned revascularization) was determined over a median follow-up of 1.1 years. LMCAD was registered in 432 of 3202 (13%) patients having coronary CTA. FFRCT was prescribed in 213 (49%), while 59 (14%) patients were referred directly to invasive angiography or myocardial perfusion imaging. FFRCT was performed in 195 (45%) patients. LM stenosis severity was inversely related to downstream FFRCT values. In patients with simple LMCAD with stenosis ≥ 50%, > 80% had FFRCT > 0.80 in non-diseased proximal and downstream segments (n = 7). No patients with simple LMCAD and FFRCT > 0.80 (n = 20) suffered an adverse clinical outcome. FFRCT testing in patients with LMCAD is feasible. LM stenosis severity is inversely related to FFRCT value. Patients with LMCAD and FFRCT > 0.80 have favorable clinical outcomes at short-term follow-up. Large-scale studies assessing the clinical utility and safety of deferring invasive catheterization following FFRCT testing in patients with LMCAD are warranted.",

keywords = "Computed tomography angiography, Coronary angiography, Coronary artery disease, Fractional flow reserve, Left main, FRACTIONAL FLOW RESERVE, STENOSIS, PERFORMANCE, GUIDELINES, COMPUTED-TOMOGRAPHY ANGIOGRAPHY, SOCIETY, IMPACT, INTRAVASCULAR ULTRASOUND, OUTCOMES, ARTERY-DISEASE, Predictive Value of Tests, Humans, Tomography, X-Ray Computed, Coronary Stenosis/diagnostic imaging, Retrospective Studies, Severity of Illness Index, Computed Tomography Angiography, Coronary Artery Disease/diagnostic imaging, Coronary Angiography, Fractional Flow Reserve, Myocardial, Coronary Vessels/diagnostic imaging",

author = "Riedl, {Katharina A} and Jensen, {Jesper M} and Ko, {Brian S} and Jonathon Leipsic and Grove, {Erik L} and Mathiassen, {Ole N} and B{\o}tker, {Hans Erik} and N{\o}rgaard, {Bjarne L}",

note = "{\textcopyright} 2021. The Author(s).",

year = "2021",

month = nov,

doi = "10.1007/s10554-021-02371-4",

language = "English",

volume = "37",

pages = "3299--3308",

journal = "The International Journal of Cardiovascular Imaging",

issn = "1569-5794",

publisher = "Springer",

number = "11",

}

Coronary CT angiography derived FFR in patients with left main disease. / Riedl, Katharina A; Jensen, Jesper M; Ko, Brian S et al.
In: The International Journal of Cardiovascular Imaging, Vol. 37, No. 11, 11.2021, p. 3299-3308.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Coronary CT angiography derived FFR in patients with left main disease

AU - Riedl, Katharina A

AU - Jensen, Jesper M

AU - Ko, Brian S

AU - Leipsic, Jonathon

AU - Grove, Erik L

AU - Mathiassen, Ole N

AU - Bøtker, Hans Erik

AU - Nørgaard, Bjarne L

PY - 2021/11

Y1 - 2021/11

N2 - The presence of left main coronary artery disease (LMCAD) is associated with an unfavorable clinical outcome. The clinical utility of FFRCT testing for non-invasive physiological assessment in LMCAD remains largely unknown. In this single center observational study LMCAD patients were retrospectively identified between November 2015 and December 2017. We evaluated the relationship between LMCAD diameter stenosis and downstream FFRCT values, and the clinical consequences following FFRCT testing in patients with LMCAD. The composite endpoint (all-cause death, myocardial infarction, unplanned revascularization) was determined over a median follow-up of 1.1 years. LMCAD was registered in 432 of 3202 (13%) patients having coronary CTA. FFRCT was prescribed in 213 (49%), while 59 (14%) patients were referred directly to invasive angiography or myocardial perfusion imaging. FFRCT was performed in 195 (45%) patients. LM stenosis severity was inversely related to downstream FFRCT values. In patients with simple LMCAD with stenosis ≥ 50%, > 80% had FFRCT > 0.80 in non-diseased proximal and downstream segments (n = 7). No patients with simple LMCAD and FFRCT > 0.80 (n = 20) suffered an adverse clinical outcome. FFRCT testing in patients with LMCAD is feasible. LM stenosis severity is inversely related to FFRCT value. Patients with LMCAD and FFRCT > 0.80 have favorable clinical outcomes at short-term follow-up. Large-scale studies assessing the clinical utility and safety of deferring invasive catheterization following FFRCT testing in patients with LMCAD are warranted.

AB - The presence of left main coronary artery disease (LMCAD) is associated with an unfavorable clinical outcome. The clinical utility of FFRCT testing for non-invasive physiological assessment in LMCAD remains largely unknown. In this single center observational study LMCAD patients were retrospectively identified between November 2015 and December 2017. We evaluated the relationship between LMCAD diameter stenosis and downstream FFRCT values, and the clinical consequences following FFRCT testing in patients with LMCAD. The composite endpoint (all-cause death, myocardial infarction, unplanned revascularization) was determined over a median follow-up of 1.1 years. LMCAD was registered in 432 of 3202 (13%) patients having coronary CTA. FFRCT was prescribed in 213 (49%), while 59 (14%) patients were referred directly to invasive angiography or myocardial perfusion imaging. FFRCT was performed in 195 (45%) patients. LM stenosis severity was inversely related to downstream FFRCT values. In patients with simple LMCAD with stenosis ≥ 50%, > 80% had FFRCT > 0.80 in non-diseased proximal and downstream segments (n = 7). No patients with simple LMCAD and FFRCT > 0.80 (n = 20) suffered an adverse clinical outcome. FFRCT testing in patients with LMCAD is feasible. LM stenosis severity is inversely related to FFRCT value. Patients with LMCAD and FFRCT > 0.80 have favorable clinical outcomes at short-term follow-up. Large-scale studies assessing the clinical utility and safety of deferring invasive catheterization following FFRCT testing in patients with LMCAD are warranted.

KW - Computed tomography angiography

KW - Coronary angiography

KW - Coronary artery disease

KW - Fractional flow reserve

KW - Left main

KW - FRACTIONAL FLOW RESERVE

KW - STENOSIS

KW - PERFORMANCE

KW - GUIDELINES

KW - COMPUTED-TOMOGRAPHY ANGIOGRAPHY

KW - SOCIETY

KW - IMPACT

KW - INTRAVASCULAR ULTRASOUND

KW - OUTCOMES

KW - ARTERY-DISEASE

KW - Predictive Value of Tests

KW - Humans

KW - Tomography, X-Ray Computed

KW - Coronary Stenosis/diagnostic imaging

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Computed Tomography Angiography

KW - Coronary Artery Disease/diagnostic imaging

KW - Coronary Angiography

KW - Fractional Flow Reserve, Myocardial

KW - Coronary Vessels/diagnostic imaging

U2 - 10.1007/s10554-021-02371-4

DO - 10.1007/s10554-021-02371-4

M3 - Journal article

C2 - 34383150

SN - 1569-5794

VL - 37

SP - 3299

EP - 3308

JO - The International Journal of Cardiovascular Imaging

JF - The International Journal of Cardiovascular Imaging

IS - 11

ER -

Coronary CT angiography derived FFR in patients with left main disease

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Keywords

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