Journal of cardiovascular computed tomography最新文献

Background: CT-derived fractional flow reserve (FFR) improves the diagnostic accuracy of coronary CT angiography (CCTA) but typically requires off-site processing. We evaluated the agreement and diagnostic accuracy of a fast (∼8-min), on-site CT-FFR algorithm against invasive FFR and its correlation with myocardial blood flow.

Methods and results: Patients with suspected chronic coronary syndrome and at least one ≥50 ​% diameter stenosis on CCTA underwent [¹⁵O]H₂O PET and invasive coronary angiography with three-vessel invasive FFR. Thirty-eight patients with 89 vessels were included for analysis. Median invasive and CT-FFR were 0.92 (IQR 0.80-0.97) and 0.84 (IQR 0.68-0.91), respectively (rho ​= ​0.75). Against invasive FFR ≤0.80 on a per-patient level, CT-FFR ≤0.80 showed 84 ​% accuracy (95 ​% CI 70-93 ​%), 100 ​% sensitivity (95 ​% CI 85-100 ​%), 62 ​% specificity (95 ​% CI 39-82 ​%), a positive predictive value (PPV) of 79 ​% (95 ​% CI 60-90 ​%), negative predictive value (NPV) of 100 ​% (95 ​% CI 72-100 ​%). Compared with ≥50 ​% diameter stenosis on CCTA on a per-vessel level, CT-FFR ≤0.80 had similar sensitivity and NPV but higher accuracy, specificity, and PPV. Both CT-FFR and invasive FFR correlated weakly with stress myocardial blood flow (rho 0.30 and 0.35, respectively) and myocardial flow reserve (rho 0.20 and 0.38, respectively).

Conclusion: A novel on-site CT-FFR algorithm demonstrates fast and very high rule-out capability and incremental rule-in potential beyond diameter stenosis for functionally significant disease determined by invasive FFR in patients with suspected stenosis at CCTA. Both measures of FFR correlated weakly with myocardial blood flow and flow reserve by [¹⁵O]H₂O PET.

Background: While coronary artery plaque burden and stenosis are important for development of ischemia, the role of lumen size remains underexplored. This study evaluated the relationship between average lumen area (ALA) and vessel-specific ischemia beyond diameter stenosis (DS) and percent atheroma volume (PAV).

Methods: This post-hoc analysis included coronary arteries from the CREDENCE (n ​= ​1716) and PACIFIC-1 (n ​= ​612) trials, involving patients with suspected stable coronary artery disease (CAD) who underwent coronary computed tomography angiography (CTA) and invasive fractional flow reserve (FFR) measurement. AI-enabled quantitative CTA was used to assess plaque burden and composition. Ischemia was defined as FFR≤0.80. Each major coronary artery was analyzed. ALA was stratified into tertiles.

Results: Larger ALA was associated with younger age, higher body mass index, and more nitrate use in both cohorts (all p ​< ​0.05). Increasing ALA correlated with lower diameter stenosis, reduced ischemia prevalence, and smaller plaque burden despite greater total plaque and non-calcified plaque volumes. In both cohorts, ischemia prevalence increased with stenosis severity, yet within each stenosis category, vessels with smaller ALA showed consistently higher ischemia rates. E.g., in CREDENCE vessels with 50 ​%-70 ​% stenosis, ischemia was observed in 60.0 ​% of small, 43.8 ​% of medium, and 27.8 ​% of large vessels (all p ​< ​0.05). Similar patterns were observed within PAV strata across all plaque subtypes. Multivariable analysis confirmed ALA independently associated with lower ischemia prevalence in both studies (both p ​< ​0.001).

Conclusions: Coronary artery lumen size significantly attenuates the relationship between atherosclerosis/stenosis and ischemia. These findings support integrating lumen assessment in coronary CTA-based risk stratification.

Background: Super-resolution deep learning reconstruction (SR-DLR) has been developed to reduce image noise and enhance spatial resolution beyond that of normal-resolution deep learning reconstruction (NR-DLR).

Purpose: To compare the diagnostic performance of CT-derived fractional flow reserve (CT-FFR) against invasive FFR using NR-DLR and SR-DLR.

Methods: In this single-center retrospective study, 129 patients (mean age, 69 years ​±11 [SD]; 94 men) who underwent coronary CT angiography followed by invasive FFR between February 2022 and March 2025 were included. CT-FFR was computed using a mesh-free simulation model. Functionally significant stenosis was defined as FFR ≤0.80. The diagnostic performance of CT-FFR was compared between NR-DLR and SR-DLR using receiver operating characteristic curve analysis.

Results: The mean invasive FFR was 0.81 ​± ​0.08, and 70 out of 157 vessels (45 ​%) had FFR ≤0.80. The mean signal-to-noise ratio was higher with SR-DLR than with NR-DLR (33.3 ​± ​6.6 vs. 23.9 ​± ​4.5, p ​< ​0.001). The area under the receiver operating characteristic curve for detecting functionally significant stenosis was higher with SR-DLR (0.85; 95 ​% CI: 0.78, 0.91) than with NR-DLR (0.72; 95 ​% CI: 0.64, 0.81; p ​< ​0.001). Diagnostic accuracy was also higher with SR-DLR (85 ​%; 134 out of 157 vessels; 95 ​% CI: 79, 90) than with NR-DLR (74 ​%; 116 out of 157 vessels; 95 ​% CI: 66, 81; p ​< ​0.001).

Conclusions: Compared with NR-DLR, SR-DLR enhances image quality and improves the diagnostic performance of CT-FFR for identifying functionally significant stenosis.

Background: Percutaneous coronary intervention (PCI) is often complicated by periprocedural myocardial injury (PMI), resulting in poor clinical outcomes. Therefore, it is important to detect plaque that causes myocardial injury before PCI and clarify the cause of the poor outcomes. We aimed to investigate the relationship between PMI and coronary plaque morphology and plaque volume determined using coronary computed tomography angiography (CCTA) in patients with chronic coronary syndrome (CCS).

Methods: Eighty-nine patients with CCS underwent elective PCI and CCTA before PCI. Plaque morphology and volume of the target and total lesions were assessed and stratified into calcified, fibrous, fibrous fatty, and low-attenuation plaque (LAP). High-risk plaque (HRP) on CCTA was defined as positive remodeling, spotty calcification, and the napkin-ring sign.

Results: Thirty-two and fifty-seven patients were classified into the PMI and non-PMI groups, respectively. The total plaque (TP) and LAP volumes of the target lesions were significantly higher in the PMI group than in the non-PMI group. The TP and LAP volumes of the target lesion on CCTA were significant independent predictors of PMI. Net reclassification and integrated discrimination improvement indices significantly improved when TP and LAP volumes were added to the reference model including clinical characteristics and HRP features. Moreover, the TP and LAP volumes of the total lesions per patient were significantly higher in the PMI group than in the non-PMI group.

Conclusion: In patients with CCS, quantitative plaque assessment using CCTA was associated with occurrence of PMI after PCI.