Abstract
Purpose: Non-invasive fractional flow reserve derived from coronary CT angiography (FFRCT) is a novel method for diagnosis of ischemic coronary lesions. Adverse plaque characteristics (APC) by coronary CT angiography (CT)–including positive remodeling (PR), low attenuation plaque (LAP) and spotty calcification (SC)–are associated with myocardial ischemia. To date, whether APCs offer additive value to FFRCT for identifying ischemia-causing lesions remains unknown. Methods: 252 patients at 17 centers in 5 countries were enrolled in the DeFACTO (Diagnostic Accuracy of Fractional Flow Reserve From Anatomic CT Angiography) study. Patients underwent CT, FFRCT, invasive coronary angiography and clinically indicated FFR in 407 lesions. FFRCT, FFR and CT were interpreted by independent core laboratories. Invasive FFR ≤0.80 was diagnostic of lesion-specific ischemia, while CT stenosis ≥70% was considered obstructive. APCs within coronary lesions by CT were defined as: (1) PR, remodeling index >1.10; (2) LAP, any voxel <30 HU; and (3) SC, nodular calcium <3 mm. Discrimination of lesion-specific ischemia was evaluated by areas under the receiver-operating-characteristics curve (AUC). Results: By FFR, ischemia was identified in 151 of 407 lesions (37%), and by CT, obstructive stenoses were identified in 166 (41%) lesions. The presence of any APC was detected in 209 (51%), with PR, LAP and SC observed in 193 (47%), 90 (22%), and 68 (17%) lesions, respectively. The discriminatory power to identify ischemia-causing lesions was 0.73 for CT stenosis alone, 0.84 for FFRCT and 0.87 for FFRCT plus all 3 APCs (p<0.01 compared to FFRCT and CT stenosis alone for both) [Figure]. ![Figure][1] ROC curves for lesion-specific ischemia Conclusions: APCs improve discrimination of ischemia-causing lesions beyond FFRCT and CT stenosis alone. [1]: pending:yes
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