Abstract
Aims: We investigated the performance of a semi-automated arterial contour algorithm by CT angiography (CTA) for assessing total coronary atheroma burden in patients with suspected coronary artery disease. Methods: A total of 373 patients referred for invasive coronary angiography (ICA) in the CORE320 multicenter study were included in this study. Patients underwent 320-row detector CT scanning for coronary angiography. In addition to quantitative CTA stenosis assessment, a novel arterial contour detection algorithm was used to quantify total coronary atheroma volume by subtracting lumen volume from vessel wall volume for the entire coronary tree using a 19-segment model. Atheroma volume was defined as the difference between vessel and lumen volume. For atheroma burden quantification in each patient, we used three parameters: 1) length normalized total atheroma volume (length normTAV) = total atheroma volume/total coronary length; 2) percent atheroma volume (PAV) = (total atheroma volume/total vessel volume) х 100; 3) Normalized total atheroma volume (TAVnorm) = (total atheroma volume/total coronary length) х mean coronary length in study population. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy for predicting clinically driven coronary revascularization within 30 days from ICA compared to an assessment based on CTA stenosis evaluation. Results: Of 373 patients, 76 patients underwent coronary revascularization. The median CTA stenosis, length normTAV, PAV, and TAVnorm were 62%, 5.8 m3/m, 54.2%, and 2845.4 mm3, respectively. The AUC of CTA stenosis assessment to predict coronary revascularization was 0.73 (95% CI, 0.69-0.78) compared to 0.69 (95% CI, 0.64-0.73) by PAV (p = 0.11). Accuracy was lower (p = 0.002) for TAVnorm and length norm TAV (AUC, 0.62; 95% CI, 0.57-0.67 for both indices). Interobserver agreement for atheroma volume was high (r = 0.99; p < 0.0001). Conclusions: A semi-automatedly derived index of atheroma volume by CTA performs similarly to expert CTA stenosis assessment for identifying patients who undergo clinically driven coronary revascularization. These results convey promise for a rapid, reliable assessment of clinically relevant coronary artery disease.
Published Version
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