PDF(Pubmed)
Abstract：
OBJECTIVE: Coronary computed tomography angiography (CTA) and fractional flow reserve by computed tomography (FFR-CT) are increasingly utilized to characterize coronary artery disease (CAD). We evaluated the feasibility of distal-vessel FFR-CT as an integrated measure of epicardial CAD that can be followed serially, assessed the CTA parameters that correlate with distal-vessel FFR-CT, and determined the combination of clinical and CTA parameters that best predict distal-vessel FFR-CT and distal-vessel FFR-CT changes.
RESULTS: Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707).
CONCLUSIONS: Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD.
RESULTS: Patients (n = 71) who underwent serial CTA scans at ≥2 years interval (median = 5.2 years) over a 14-year period were included in this retrospective study. Coronary arteries were analysed blindly using artificial intelligence-enabled quantitative coronary CTA. Two investigators jointly determined the anatomic location and corresponding distal-vessel FFR-CT values at CT1 and CT2. A total of 45.3% had no significant change, 27.8% an improvement, and 26.9% a worsening in distal-vessel FFR-CT at CT2. Stepwise multiple logistic regression analysis identified a four-parameter model consisting of stenosis diameter ratio, lumen volume, low density plaque volume, and age, that best predicted distal-vessel FFR-CT ≤ 0.80 with an area under the curve (AUC) = 0.820 at CT1 and AUC = 0.799 at CT2. Improvement of distal-vessel FFR-CT was captured by a decrease in high-risk plaque and increases in lumen volume and remodelling index (AUC = 0.865), whereas increases in stenosis diameter ratio, medium density calcified plaque volume, and total cholesterol presaged worsening of distal-vessel FFR-CT (AUC = 0.707).
CONCLUSIONS: Distal-vessel FFR-CT permits the integrative assessment of epicardial atherosclerotic plaque burden in a vessel-specific manner and can be followed serially to determine changes in global CAD.
摘要：
目的：冠状动脉计算机断层扫描血管造影（CTA）和计算机断层扫描血流储备分数（FFR-CT）越来越多地用于表征冠状动脉疾病（CAD）。我们评估了远端血管FFR-CT作为心外膜CAD的综合措施的可行性，可以连续随访，评估与远端血管FFR-CT相关的CTA参数，并确定了临床和CTA参数的组合，这些参数可以最好地预测远端血管FFR-CT和远端血管FFR-CT的变化。
结果：这项回顾性研究包括在14年期间间隔≥2年（中位数=5.2年）接受系列CTA扫描的患者（n=71）。使用人工智能支持的定量冠状动脉CTA盲目分析冠状动脉。两名研究人员共同确定了CT1和CT2处的解剖位置和相应的远端血管FFR-CT值。45.3%无明显变化,27.8%的改善，CT2时远端血管FFR-CT恶化为26.9%。逐步多元逻辑回归分析确定了由狭窄直径比组成的四参数模型，管腔容积,低密度斑块体积，和年龄,最佳预测远端血管FFR-CT≤0.80,CT1处曲线下面积(AUC)=0.820,CT2处AUC=0.799。远端血管FFR-CT的改善是由于高危斑块的减少和管腔体积和重塑指数的增加（AUC=0.865），而狭窄直径比率增加，中密度钙化斑块体积，和总胆固醇预示远端血管FFR-CT恶化（AUC=0.707）。
结论：远端血管FFR-CT允许以血管特异性方式对心外膜动脉粥样硬化斑块负荷进行综合评估，并且可以连续跟踪以确定整体CAD的变化。
结果：这项回顾性研究包括在14年期间间隔≥2年（中位数=5.2年）接受系列CTA扫描的患者（n=71）。使用人工智能支持的定量冠状动脉CTA盲目分析冠状动脉。两名研究人员共同确定了CT1和CT2处的解剖位置和相应的远端血管FFR-CT值。45.3%无明显变化,27.8%的改善，CT2时远端血管FFR-CT恶化为26.9%。逐步多元逻辑回归分析确定了由狭窄直径比组成的四参数模型，管腔容积,低密度斑块体积，和年龄,最佳预测远端血管FFR-CT≤0.80,CT1处曲线下面积(AUC)=0.820,CT2处AUC=0.799。远端血管FFR-CT的改善是由于高危斑块的减少和管腔体积和重塑指数的增加（AUC=0.865），而狭窄直径比率增加，中密度钙化斑块体积，和总胆固醇预示远端血管FFR-CT恶化（AUC=0.707）。
结论：远端血管FFR-CT允许以血管特异性方式对心外膜动脉粥样硬化斑块负荷进行综合评估，并且可以连续跟踪以确定整体CAD的变化。
