Journal of cardiology · 2022
Prognostic value of the optimal measurement location of on-site CT-derived fractional flow reserve.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Nozaki Yui O, Fujimoto Shinichiro, Kawaguchi Yuko O, Aoshima Chihiro, Kamo Yuki, Sato Hideyuki, Kudo Hikaru, Takamura Kazuhisa, Kudo Ayako, Takahashi Daigo, Hiki Makoto, Dohi Tomotaka, Tomizawa Nobuo, Kumamaru Kanako K, Aoki Shigeki, Minamino Tohru
Аннотация
BACKGROUND: On-site computed tomography-derived fractional flow reserve (CT-FFR), using fluid structure interaction during multiple optimal diastolic phases, is of incremental diagnostic value. However, few studies have investigated prognosis, with the appropriate measurement location of CT-FFR, as a stand-alone modality. The aim of the present study was to assess the clinical impact on CT-FFR with an appropriate measurement.
METHODS: A total of 370 consecutive patients (68 ± 10 years, 75% male) who underwent coronary CT angiography (CCTA), showing 50-90% stenosis in at least one major epicardial vessel, were retrospectively analyzed and followed up for a median 2.9 years. CT-FFR values were measured at three points: 1 to 2 cm distal to the target lesion (CT-FFR1cm, 2cm) and the vessel terminus (CT-FFRlowest), and a CT-FFR value ≤0.80 was considered to be abnormal. The endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction, and unplanned revascularization.
RESULTS: The incidence of MACE was 6.8% (25/370 patients). The Kaplan-Meier survival analysis in negative CT-FFR1/2cm revealed no significant difference in MACE between negative and positive CT-FFRlowest [p = 0.11/0.23 (1/2 cm vs lowest)]. Among 221 patients who did not undergo planned revascularization within 90 days of CCTA, no significant differences were noted in the incidence of MACE between negative and positive CT-FFRlowest (p = 0.11). In contrast, the risk of MACE was significantly higher with positive CT-FFR1/2cm [p = 0.0198/0.0002 (1/2 cm)].
CONCLUSIONS: In terms of the prognosis of patients with moderate to severe stenosis on CCTA, CT-FFR measured 1 to 2 cm distal to the target lesion may be feasible for the safe deferral of unnecessary invasive coronary angiography. Moreover, CT-FFR1/2cm showed better risk stratification than CT-FFRlowest based on future adverse cardiac events.
METHODS: A total of 370 consecutive patients (68 ± 10 years, 75% male) who underwent coronary CT angiography (CCTA), showing 50-90% stenosis in at least one major epicardial vessel, were retrospectively analyzed and followed up for a median 2.9 years. CT-FFR values were measured at three points: 1 to 2 cm distal to the target lesion (CT-FFR1cm, 2cm) and the vessel terminus (CT-FFRlowest), and a CT-FFR value ≤0.80 was considered to be abnormal. The endpoint was major adverse cardiovascular events (MACE), a composite of cardiac death, non-fatal myocardial infarction, and unplanned revascularization.
RESULTS: The incidence of MACE was 6.8% (25/370 patients). The Kaplan-Meier survival analysis in negative CT-FFR1/2cm revealed no significant difference in MACE between negative and positive CT-FFRlowest [p = 0.11/0.23 (1/2 cm vs lowest)]. Among 221 patients who did not undergo planned revascularization within 90 days of CCTA, no significant differences were noted in the incidence of MACE between negative and positive CT-FFRlowest (p = 0.11). In contrast, the risk of MACE was significantly higher with positive CT-FFR1/2cm [p = 0.0198/0.0002 (1/2 cm)].
CONCLUSIONS: In terms of the prognosis of patients with moderate to severe stenosis on CCTA, CT-FFR measured 1 to 2 cm distal to the target lesion may be feasible for the safe deferral of unnecessary invasive coronary angiography. Moreover, CT-FFR1/2cm showed better risk stratification than CT-FFRlowest based on future adverse cardiac events.