TY - JOUR
T1 - Effect of Plaque Burden and Morphology on Myocardial Blood Flow and Fractional Flow Reserve
AU - Driessen, Roel S.
AU - Stuijfzand, Wijnand J.
AU - Raijmakers, Pieter G.
AU - Danad, Ibrahim
AU - Min, James K.
AU - Leipsic, Jonathon A.
AU - Ahmadi, Amir
AU - Narula, Jagat
AU - van de Ven, Peter M.
AU - Huisman, Marc C.
AU - Lammertsma, Adriaan A.
AU - van Rossum, Albert C.
AU - van Royen, Niels
AU - Knaapen, Paul
PY - 2018/2/6
Y1 - 2018/2/6
N2 - Background: Atherosclerotic plaque characteristics may affect downstream myocardial perfusion, as well as coronary lesion severity. Objectives: This study sought to evaluate the association between quantitative plaque burden and plaque morphology obtained using coronary computed tomography angiography (CTA) and quantitative myocardial perfusion obtained using [15O]H2O positron emission tomography (PET), as well as fractional flow reserve (FFR) derived invasively. Methods: Two hundred eight patients (63% men; age 58 ± 8.7 years) with suspected coronary artery disease were prospectively included. All patients underwent 256-slice coronary CTA, [15O]H2O PET, and invasive FFR measurements. Coronary CTA-derived plaque burden and morphology were assessed using commercially available software and compared with PET perfusion and FFR. Results: Atherosclerotic plaques were present in 179 patients (86%) and 415 of 610 (68%) evaluable coronary arteries. On a per-vessel basis, traditional coronary plaque burden indexes, such as plaque length and volume, minimal lumen area, and stenosis percentage, were significantly associated with impaired hyperemic myocardial blood flow (MBF) and FFR. In addition, morphological features, such as partially calcified plaques, positive remodeling (PR), and low attenuation plaque, displayed a negative impact on hyperemic MBF and FFR. Multivariable analysis revealed that the morphological feature of PR was independently related to impaired hyperemic MBF as well as an unfavorable FFR (p = 0.004 and p = 0.007, respectively), next to stenosis percentage (p = 0.001 and p < 0.001, respectively) and noncalcified plaque volume (p < 0.001 and p = 0.010, respectively). Conclusions: PR and noncalcified plaque volume are associated with detrimental downstream hyperemic myocardial perfusion and FFR, independent of lesion severity.
AB - Background: Atherosclerotic plaque characteristics may affect downstream myocardial perfusion, as well as coronary lesion severity. Objectives: This study sought to evaluate the association between quantitative plaque burden and plaque morphology obtained using coronary computed tomography angiography (CTA) and quantitative myocardial perfusion obtained using [15O]H2O positron emission tomography (PET), as well as fractional flow reserve (FFR) derived invasively. Methods: Two hundred eight patients (63% men; age 58 ± 8.7 years) with suspected coronary artery disease were prospectively included. All patients underwent 256-slice coronary CTA, [15O]H2O PET, and invasive FFR measurements. Coronary CTA-derived plaque burden and morphology were assessed using commercially available software and compared with PET perfusion and FFR. Results: Atherosclerotic plaques were present in 179 patients (86%) and 415 of 610 (68%) evaluable coronary arteries. On a per-vessel basis, traditional coronary plaque burden indexes, such as plaque length and volume, minimal lumen area, and stenosis percentage, were significantly associated with impaired hyperemic myocardial blood flow (MBF) and FFR. In addition, morphological features, such as partially calcified plaques, positive remodeling (PR), and low attenuation plaque, displayed a negative impact on hyperemic MBF and FFR. Multivariable analysis revealed that the morphological feature of PR was independently related to impaired hyperemic MBF as well as an unfavorable FFR (p = 0.004 and p = 0.007, respectively), next to stenosis percentage (p = 0.001 and p < 0.001, respectively) and noncalcified plaque volume (p < 0.001 and p = 0.010, respectively). Conclusions: PR and noncalcified plaque volume are associated with detrimental downstream hyperemic myocardial perfusion and FFR, independent of lesion severity.
KW - Atherosclerosis
KW - Calcification
KW - Coronary angiography
KW - FFR
KW - PET imaging
KW - Plaque instability
KW - Plaque, Atherosclerotic
KW - Remodeling
KW - coronary artery disease
KW - coronary computed tomography angiography
KW - fractional flow reserve
KW - myocardial blood flow
KW - myocardial perfusion
KW - myocardial perfusion imaging: PET
KW - plaque
KW - positron emission tomography
UR - http://www.scopus.com/inward/record.url?scp=85044852202&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jacc.2017.11.054
DO - https://doi.org/10.1016/j.jacc.2017.11.054
M3 - Article
C2 - 29406855
SN - 0735-1097
VL - 71
SP - 499
EP - 509
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 5
ER -