Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.01.003
B. Kelly Han , Cynthia K. Rigsby , Tarique Hussain , Anthony Hlavacek , Anjali Chelliah , Kanwal M. Farooqi , Jennifer Cohen , Timothy Slesnick , Rajesh Krishnamurthy , Taylor Chung , Prachi P. Agarwal , Ashwin Prakash , Sunil Ghelani , Aurelio Secinaro , Brian Ghoshhadra , Shazia Mohsin , Aloha Maeve , Mahesh Kappanayil , Renee P. Bullock-Palmer , Cristina Fuss , Edward D. Nicol
Background
Cardiac Computed Tomography (CCT) is increasingly used for evaluation of congenital heart disease (CHD) in patients of all ages. Pediatric and adult congenital heart disease (ACHD) surgical programs require high quality CCT imaging as part of the multimodality imaging support expected of comprehensive care centers. Despite these expectations, there are no benchmarks or defined programmatic elements specific to the performance of CCT in patients with CHD.
To address this deficit, this manuscript is written by a group of current CHD CCT practitioners and provides a collective opinion regarding the clinical components required, and essential resources needed, to deliver a comprehensive CCT CHD imaging program. Resource allocation was divided into CCT technology, imaging technologist, physician and programmatic support. The group is inclusive of pediatric and adult cardiologists and radiologists and includes practitioners from high and lower resourced programs and countries. Imaging settings are inclusive of academic and private practice, heart centers and combined radiology/cardiology service lines. Challenges and areas for future advocacy to support this growing specialty are proposed to improve performance standards that will consider the expected widespread variation in technical and staffing resources, skillsets, and practice settings for CT in CHD.
Summary
High quality cardiovascular computed tomography is an essential component of pediatric and adult congenital programs and surgical centers. Program growth outpaces resource allocation in most institutions. This opinion paper outlines essential components for technical, technologist and physician resources and programmatic support to develop and maintain a successful CCT in CHD program. Although a small component of most cardiac imaging programs, it is an essential component particularly in complex cases. Institutional and imaging societal commitment is essential to support this emerging field at highest quality.
{"title":"Proposed resources required for a comprehensive program for CCT CHD imaging","authors":"B. Kelly Han , Cynthia K. Rigsby , Tarique Hussain , Anthony Hlavacek , Anjali Chelliah , Kanwal M. Farooqi , Jennifer Cohen , Timothy Slesnick , Rajesh Krishnamurthy , Taylor Chung , Prachi P. Agarwal , Ashwin Prakash , Sunil Ghelani , Aurelio Secinaro , Brian Ghoshhadra , Shazia Mohsin , Aloha Maeve , Mahesh Kappanayil , Renee P. Bullock-Palmer , Cristina Fuss , Edward D. Nicol","doi":"10.1016/j.jcct.2025.01.003","DOIUrl":"10.1016/j.jcct.2025.01.003","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac Computed Tomography<span><span><span> (CCT) is increasingly used for evaluation of congenital heart disease (CHD) in patients of all ages. Pediatric and </span>adult congenital heart disease (ACHD) surgical programs require high quality CCT imaging as part of the </span>multimodality imaging support expected of comprehensive care centers. Despite these expectations, there are no benchmarks or defined programmatic elements specific to the performance of CCT in patients with CHD.</span></div><div>To address this deficit, this manuscript is written by a group of current CHD CCT practitioners and provides a collective opinion regarding the clinical components required, and essential resources needed, to deliver a comprehensive CCT CHD imaging program. Resource allocation was divided into CCT technology, imaging technologist, physician and programmatic support. The group is inclusive of pediatric and adult cardiologists and radiologists and includes practitioners from high and lower resourced programs and countries. Imaging settings are inclusive of academic and private practice, heart centers and combined radiology/cardiology service lines. Challenges and areas for future advocacy to support this growing specialty are proposed to improve performance standards that will consider the expected widespread variation in technical and staffing resources, skillsets, and practice settings for CT in CHD.</div></div><div><h3>Summary</h3><div>High quality cardiovascular computed tomography<span> is an essential component of pediatric and adult congenital programs and surgical centers. Program growth outpaces resource allocation in most institutions. This opinion paper outlines essential components for technical, technologist and physician resources and programmatic support to develop and maintain a successful CCT in CHD program. Although a small component of most cardiac imaging programs, it is an essential component particularly in complex cases. Institutional and imaging societal commitment is essential to support this emerging field at highest quality.</span></div></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 729-735"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.07.004
Morteza Naghavi, Kyle Atlas, Anthony P. Reeves, Chenyu Zhang, Thomas Atlas, Sion K. Roy, Matthew J. Budoff, Claudia I. Henschke, David F. Yankelevitz, Jagat Narula, Nathan D. Wong
{"title":"AI-enabled opportunistic left ventricular volumetry in coronary artery calcium scans predicts heart failure comparably to cardiac MRI: An AI-CVD study with the Multi-Ethnic Study of Atherosclerosis (MESA)","authors":"Morteza Naghavi, Kyle Atlas, Anthony P. Reeves, Chenyu Zhang, Thomas Atlas, Sion K. Roy, Matthew J. Budoff, Claudia I. Henschke, David F. Yankelevitz, Jagat Narula, Nathan D. Wong","doi":"10.1016/j.jcct.2025.07.004","DOIUrl":"10.1016/j.jcct.2025.07.004","url":null,"abstract":"","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 717-719"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.10.013
Ismail Mikdat Kabakus, Jordan H. Chamberlin, Dhiraj Baruah
Ultra-high-resolution (UHR) photon-counting detector CT represents a significant advancement in coronary CT angiography (CCTA), offering 0.2 mm spatial resolution and enhanced spectral capabilities. This article presents practical insights and optimized protocols from a high-volume center, focusing on acquisition, reconstruction, and contrast techniques tailored for UHR cardiac imaging. Recommendations address patient selection, workflow integration, and technical challenges, aiming to guide broader clinical adoption and ensure consistent, high-quality imaging outcomes with this emerging technology.
{"title":"Ultrahigh-resolution photon-counting detector coronary CT angiography: Practical insights and workflow integration from a high-volume center","authors":"Ismail Mikdat Kabakus, Jordan H. Chamberlin, Dhiraj Baruah","doi":"10.1016/j.jcct.2025.10.013","DOIUrl":"10.1016/j.jcct.2025.10.013","url":null,"abstract":"<div><div>Ultra-high-resolution (UHR) photon-counting detector CT represents a significant advancement in coronary CT angiography (CCTA), offering 0.2 mm spatial resolution and enhanced spectral capabilities. This article presents practical insights and optimized protocols from a high-volume center, focusing on acquisition, reconstruction, and contrast techniques tailored for UHR cardiac imaging. Recommendations address patient selection, workflow integration, and technical challenges, aiming to guide broader clinical adoption and ensure consistent, high-quality imaging outcomes with this emerging technology.</div></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 711-714"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145380457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.06.009
Nikhil Patel , Jennifer Cohen , Hari G. Rajagopal , David M. Barris , Kenan W.D. Stern , Nadine F. Choueiter , Kali A. Hopkins , Gina LaRocca , Adam Jacobi , Barry Love , Robert H. Pass , Ali N. Zaidi , Son Q. Duong
Background
Cardiac CT (CCT) is important for anatomic evaluation of congenital heart disease (CHD) prior to pulmonary valve replacement (PVR). However, volumetric and functional criteria for PVR are derived from cardiac MRI (CMR). Systematic differences between CCT and CMR volumes are underexplored in patients with CHD.
Methods
Retrospective review of CHD patients with CMR and single-source CCT<180 days apart. Ventricular volumes were recontoured by blinded experts and global agreement was compared. Right ventricular regional differences in contours were assessed. Agreement of CCT with CMR-defined criteria for PVR was reported.
Results
Twenty-nine patients (mean age 33 years, 48 % tetralogy of Fallot, 24 % congenital pulmonary stenosis, 83 % evaluated for PVR) had average CMR RVEDVi 152 mL/m2, RVESVi 80 mL/m2, RVEF 49 %, and RVEDV:LVEDV 1.9:1. CCT measured significantly higher RVEDVi (mean difference (MD) +17 mL/m2), RVESVi (MD +17 mL/m2), and RVEDV:LVEDV (MD +0.1) with no difference in stroke volume. There was a lower RVEF (MD -5 %). CCT had 90–100 % sensitivity/NPV to identify CMR-defined RV PVR thresholds, but had lower specificity and PPV. Faster heart rates had higher RVESVi CCT-CMR difference. The basal and mid-inferior RV contours contributed the most to CCT-CMR differences.
Conclusions
Single-source CCT measures higher RV volumes and lower EF compared to CMR (i.e. more adversely-remodeled). Mechanisms include inferior stretch due to differences in breathing-instruction, and misidentification of end-systole. CMR-derived PVR thresholds applied to CCT would lead to more proactive intervention. “Adjusting” single-source CCT volumes by the observed difference between modalities is a reasonable approach. Single-source CCT-specific volumetric recommendations for PVR are needed.
{"title":"Comparison of single-source cardiac CT and CMR quantified ventricular volumes and function in congenital heart disease","authors":"Nikhil Patel , Jennifer Cohen , Hari G. Rajagopal , David M. Barris , Kenan W.D. Stern , Nadine F. Choueiter , Kali A. Hopkins , Gina LaRocca , Adam Jacobi , Barry Love , Robert H. Pass , Ali N. Zaidi , Son Q. Duong","doi":"10.1016/j.jcct.2025.06.009","DOIUrl":"10.1016/j.jcct.2025.06.009","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Cardiac CT (CCT) is important for anatomic evaluation of congenital heart disease (CHD) prior to </span>pulmonary valve replacement (PVR). However, volumetric and functional criteria for PVR are derived from </span>cardiac MRI (CMR). Systematic differences between CCT and CMR volumes are underexplored in patients with CHD.</div></div><div><h3>Methods</h3><div>Retrospective review of CHD patients with CMR and single-source CCT<180 days apart. Ventricular volumes were recontoured by blinded experts and global agreement was compared. Right ventricular regional differences in contours were assessed. Agreement of CCT with CMR-defined criteria for PVR was reported.</div></div><div><h3>Results</h3><div><span>Twenty-nine patients (mean age 33 years, 48 % tetralogy of Fallot<span>, 24 % congenital pulmonary stenosis, 83 % evaluated for PVR) had average CMR RVEDVi 152 mL/m</span></span><sup>2</sup>, RVESVi 80 mL/m<sup>2</sup>, RVEF 49 %, and RVEDV:LVEDV 1.9:1. CCT measured significantly higher RVEDVi (mean difference (MD) +17 mL/m<sup>2</sup>), RVESVi (MD +17 mL/m<sup>2</sup>), and RVEDV:LVEDV (MD +0.1) with no difference in stroke volume. There was a lower RVEF (MD -5 %). CCT had 90–100 % sensitivity/NPV to identify CMR-defined RV PVR thresholds, but had lower specificity and PPV. Faster heart rates had higher RVESVi CCT-CMR difference. The basal and mid-inferior RV contours contributed the most to CCT-CMR differences.</div></div><div><h3>Conclusions</h3><div><span>Single-source CCT measures higher RV volumes and lower EF compared to CMR (i.e. more adversely-remodeled). Mechanisms include inferior stretch due to differences in breathing-instruction, and misidentification of end-systole. CMR-derived PVR thresholds applied to CCT would lead to more proactive intervention. “Adjusting” single-source </span>CCT volumes by the observed difference between modalities is a reasonable approach. Single-source CCT-specific volumetric recommendations for PVR are needed.</div></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 779-788"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.07.007
Victor A. Verpalen, Willem R.van de Vijver, Olivier H. Gonçalves Silveirinha, Casper F. Coerkamp, Bimmer E.P.M. Claessen, G. Aernout Somsen, Klaas Jan Franssen, Igor I. Tulevski, Michiel M. Winter, Jose P.S. Henriques, Richard A.P. Takx, R. Nils Planken
{"title":"The effect of metoprolol on heart rate before coronary CT angiography: Lessons and recommendations from a large cohort","authors":"Victor A. Verpalen, Willem R.van de Vijver, Olivier H. Gonçalves Silveirinha, Casper F. Coerkamp, Bimmer E.P.M. Claessen, G. Aernout Somsen, Klaas Jan Franssen, Igor I. Tulevski, Michiel M. Winter, Jose P.S. Henriques, Richard A.P. Takx, R. Nils Planken","doi":"10.1016/j.jcct.2025.07.007","DOIUrl":"10.1016/j.jcct.2025.07.007","url":null,"abstract":"","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 720-722"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144801354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.07.003
Brennan J. Vogl , Joseph Chibuike Nwokeafor , Emily Hyatt , Emily Vitale , Ahmad Bshennaty , Simon Lee , John Kovalchin , James Gaensbauer , Guy Hembroff , Hoda Hatoum
Background
Untreated Kawasaki Disease (KD) can lead to coronary artery (CA) dilations, such as CA aneurysms (CAA), CA ectasia (CAE), or both (CAA + CAE). Currently, therapeutic decisions rely solely on geometric measurements, which have limitations. This study aims to correlate differences in flow dynamics between CAA, CAE, and CAA + CAE with clinical outcomes and thrombotic potential.
Methods
A multicenter retrospective study was performed using a total of 50 dilation models from patients with KD. Dilations were categorized as either CAA (n = 30), CAE (n = 14), or CAA + CAE (n = 6). Patient-specific 3D digital models of the CAs were created for each patient. Geometric measurements of each CA were recorded. Flow simulations were conducted and hemodynamic metrics such as time average wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and normalized average wall shear stress divergence (AWSS) were calculated.
Results
CAAs had the largest dilations and entrance diameters. The dilation length and aspect ratio were higher for CAEs. CAAs exhibited consistently low velocity and low TAWSS with extensive regions of co-localized high RRT and OSI, and AWSS source points. CAEs showed elevated RRT in some cases but minimal OSI with little spatial overlap between metrics. CAA+CAEs showed variable and diffuse flow patterns with limited co-localization.
Conclusion
Flow dynamics vary significantly across dilation morphologies in KD. Patients with only CAAs present hemodynamic data associated with the highest likelihood of thrombosis. Hemodynamic metrics may serve as mechanistic markers for thrombogenic potential and should be considered alongside anatomical measurements in future risk stratification efforts.
{"title":"Flow dynamic differences between Kawasaki Disease patients with coronary artery aneurysms and ectasia","authors":"Brennan J. Vogl , Joseph Chibuike Nwokeafor , Emily Hyatt , Emily Vitale , Ahmad Bshennaty , Simon Lee , John Kovalchin , James Gaensbauer , Guy Hembroff , Hoda Hatoum","doi":"10.1016/j.jcct.2025.07.003","DOIUrl":"10.1016/j.jcct.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Untreated Kawasaki Disease<span><span> (KD) can lead to coronary artery<span> (CA) dilations, such as CA aneurysms<span> (CAA), CA </span></span></span>ectasia<span><span> (CAE), or both (CAA + CAE). Currently, therapeutic decisions rely solely on geometric measurements, which have limitations. This study aims to correlate differences in flow dynamics between CAA, </span>CAE, and CAA + CAE with clinical outcomes and thrombotic potential.</span></span></div></div><div><h3>Methods</h3><div><span>A multicenter retrospective study was performed using a total of 50 dilation models from patients with KD. Dilations were categorized as either CAA (n = 30), CAE (n = 14), or CAA + CAE (n = 6). Patient-specific 3D digital models of the CAs were created for each patient. Geometric measurements of each CA were recorded. Flow simulations were conducted and </span>hemodynamic<span> metrics such as time average wall shear stress<span> (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and normalized average wall shear stress divergence (AWSS) were calculated.</span></span></div></div><div><h3>Results</h3><div><span>CAAs had the largest dilations and entrance diameters. The dilation length and aspect ratio were higher for CAEs. CAAs exhibited consistently low velocity and low TAWSS with extensive regions of co-localized high RRT and OSI, and AWSS </span>source points. CAEs showed elevated RRT in some cases but minimal OSI with little spatial overlap between metrics. CAA+CAEs showed variable and diffuse flow patterns with limited co-localization.</div></div><div><h3>Conclusion</h3><div>Flow dynamics vary significantly across dilation morphologies in KD. Patients with only CAAs present hemodynamic<span> data associated with the highest likelihood of thrombosis. Hemodynamic metrics may serve as mechanistic markers for thrombogenic potential and should be considered alongside anatomical measurements in future risk stratification efforts.</span></div></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 789-799"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.jcct.2025.09.001
Kotaro Miyashita , Yoshinobu Onuma , Asahi Oshima , Akihiro Tobe , Tsung-Ying Tsai , Pruthvi C. Revaiah , Shengxian Tu , Johan H.C. Reiber , Daniele Andreini , Saima Mushtaq , Gianluca Pontone , Giulio Pompilio , Johan De Mey , Kaoru Tanaka , Mark La Meir , Hristo Kirov , Torsten Doenst , Ulf Teichgräber , Jagat Narula , John D. Puskas , Patrick W. Serruys
Background
Diagnostic concordance among Fractional Flow Reserve derived from computed tomography (FFRCT), and the Quantitative flow ratio (QFR) and Murray's Law-based QFR (μFR) derived from invasive coronary angiography (ICA) is implicitly assumed.
Methods
Coronary CT angiography (CCTA) and ICA were analyzed in a central imaging core lab in this post-hoc imaging sub-study of the FASTTRACK CABG trial that enrolled 114 patients with de-novo three-vessel and/or left-main coronary artery disease. FFRCT, QFR, and μFR were analyzed at corresponding bifurcation points on CCTA and ICA, and virtual pullback pressure gradient index (PPGi) and FFR derivatives (dFFR/ds) were assessed to patho-physiologically categorize the lesion phenotype into diffuse or focal.
Results
In 199 vessels, mean distal estimates of FFRCT (0.70), QFR (0.71), and μFR (0.69) were similar (p = 0.127). QFR was significantly higher than FFRCT (p < 0.01) and μFR (p < 0.01) in the main branches of the two most proximal bifurcations. Concordance between FFRCT and QFR, and FFRCT and μFR was 76.3 % (kappa = 0.451) and 80.3 % (kappa = 0.544), respectively, when using a cut-off of ≤0.80. Concordance in the pathophysiological lesion phenotype (diffuse or focal) as derived from virtual PPGi was poor between FFRCT vs QFR (k = 0.04) and FFRCT vs μFR (k = 0.16). QFR (20.9 %) tended to identify focal lesions more frequently than FFRCT (13.4 %) and μFR (7.5 %).
Conclusions
In the two most proximal bifurcations, QFR values were higher than FFRCT and μFR, resulting in lesion severity being underestimated, which may impact revascularization decisions. The pathophysiological phenotype classification was poorly correlated among FFRCT, QFR, and μFR.
{"title":"Fractional flow reserve from coronary CT angiography compared with quantitative flow ratio in complex CAD","authors":"Kotaro Miyashita , Yoshinobu Onuma , Asahi Oshima , Akihiro Tobe , Tsung-Ying Tsai , Pruthvi C. Revaiah , Shengxian Tu , Johan H.C. Reiber , Daniele Andreini , Saima Mushtaq , Gianluca Pontone , Giulio Pompilio , Johan De Mey , Kaoru Tanaka , Mark La Meir , Hristo Kirov , Torsten Doenst , Ulf Teichgräber , Jagat Narula , John D. Puskas , Patrick W. Serruys","doi":"10.1016/j.jcct.2025.09.001","DOIUrl":"10.1016/j.jcct.2025.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Diagnostic concordance among Fractional Flow Reserve derived from computed tomography (FFR<sub>CT</sub>), and the Quantitative flow ratio (QFR) and Murray's Law-based QFR (μFR) derived from invasive coronary angiography (ICA) is implicitly assumed.</div></div><div><h3>Methods</h3><div>Coronary CT angiography (CCTA) and ICA were analyzed in a central imaging core lab in this post-hoc imaging sub-study of the FASTTRACK CABG trial that enrolled 114 patients with de-novo three-vessel and/or left-main coronary artery disease. FFR<sub>CT</sub>, QFR, and μFR were analyzed at corresponding bifurcation points on CCTA and ICA, and virtual pullback pressure gradient index (PPGi) and FFR derivatives (dFFR/ds) were assessed to patho-physiologically categorize the lesion phenotype into diffuse or focal.</div></div><div><h3>Results</h3><div>In 199 vessels, mean distal estimates of FFR<sub>CT</sub> (0.70), QFR (0.71), and μFR (0.69) were similar (p = 0.127). QFR was significantly higher than FFR<sub>CT</sub> (p < 0.01) and μFR (p < 0.01) in the main branches of the two most proximal bifurcations. Concordance between FFR<sub>CT</sub> and QFR, and FFR<sub>CT</sub> and μFR was 76.3 % (kappa = 0.451) and 80.3 % (kappa = 0.544), respectively, when using a cut-off of ≤0.80. Concordance in the pathophysiological lesion phenotype (diffuse or focal) as derived from virtual PPGi was poor between FFR<sub>CT</sub> vs QFR (k = 0.04) and FFR<sub>CT</sub> vs μFR (k = 0.16). QFR (20.9 %) tended to identify focal lesions more frequently than FFR<sub>CT</sub> (13.4 %) and μFR (7.5 %).</div></div><div><h3>Conclusions</h3><div>In the two most proximal bifurcations, QFR values were higher than FFR<sub>CT</sub> and μFR, resulting in lesion severity being underestimated, which may impact revascularization decisions. The pathophysiological phenotype classification was poorly correlated among FFR<sub>CT</sub>, QFR, and μFR.</div></div><div><h3>Trial registration number</h3><div>NCT04142021.</div></div>","PeriodicalId":49039,"journal":{"name":"Journal of Cardiovascular Computed Tomography","volume":"19 6","pages":"Pages 701-710"},"PeriodicalIF":5.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145126873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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