Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial

Maros Ferencik, Michael T. Lu, Thomas Mayrhofer, Stefan B. Puchner, Ting Liu, Pal Maurovich-Horvat, Khristine Ghemigian, Alexander Ivanov, Elizabeth Adami, John T. Nagurney, Pamela K. Woodard, Quynh A. Truong, James E. Udelson, Udo Hoffmann

    Research output: Contribution to journalArticle

    Abstract

    Background: Non-invasive fractional flow reserve (FFR CT ) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFR CT in the population of acute chest pain patients and assessed the relationship of FFR CT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFR CT was measured in a core laboratory. Results: We found correlation between anatomic severity of stenosis and FFR CT ≤0.80 vs. FFR CT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFR CT values (median 0.64, 25th-75th percentile 0.50–0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78–0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFR CT ≤0.80 was 4.03 (95% CI 1.56–10.36) and 3.50 (95% CI 1.12–10.96), respectively. FFR CT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55–9.85, p = 0.004) after adjustment for stenosis severity. Conclusion: Abnormal FFR CT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFR CT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.

    Original languageEnglish (US)
    JournalJournal of Cardiovascular Computed Tomography
    DOIs
    StatePublished - Jan 1 2019

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    Acute Pain
    Chest Pain
    Pathologic Constriction
    Coronary Stenosis
    Acute Coronary Syndrome
    Computed Tomography Angiography
    Exercise Test
    Population
    Hemodynamics
    Odds Ratio

    Keywords

    • Acute coronary syndrome
    • Coronary computed tomography angiography
    • Non-invasive cardiac testing
    • Non-invasive fractional flow reserve
    • Risk stratification
    • Stress test

    ASJC Scopus subject areas

    • Radiology Nuclear Medicine and imaging
    • Cardiology and Cardiovascular Medicine

    Cite this

    Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain : Subgroup analysis of the ROMICAT II trial. / Ferencik, Maros; Lu, Michael T.; Mayrhofer, Thomas; Puchner, Stefan B.; Liu, Ting; Maurovich-Horvat, Pal; Ghemigian, Khristine; Ivanov, Alexander; Adami, Elizabeth; Nagurney, John T.; Woodard, Pamela K.; Truong, Quynh A.; Udelson, James E.; Hoffmann, Udo.

    In: Journal of Cardiovascular Computed Tomography, 01.01.2019.

    Research output: Contribution to journalArticle

    Ferencik, M, Lu, MT, Mayrhofer, T, Puchner, SB, Liu, T, Maurovich-Horvat, P, Ghemigian, K, Ivanov, A, Adami, E, Nagurney, JT, Woodard, PK, Truong, QA, Udelson, JE & Hoffmann, U 2019, 'Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial', Journal of Cardiovascular Computed Tomography. https://doi.org/10.1016/j.jcct.2019.05.009
    Ferencik, Maros ; Lu, Michael T. ; Mayrhofer, Thomas ; Puchner, Stefan B. ; Liu, Ting ; Maurovich-Horvat, Pal ; Ghemigian, Khristine ; Ivanov, Alexander ; Adami, Elizabeth ; Nagurney, John T. ; Woodard, Pamela K. ; Truong, Quynh A. ; Udelson, James E. ; Hoffmann, Udo. / Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain : Subgroup analysis of the ROMICAT II trial. In: Journal of Cardiovascular Computed Tomography. 2019.
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    title = "Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain: Subgroup analysis of the ROMICAT II trial",
    abstract = "Background: Non-invasive fractional flow reserve (FFR CT ) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFR CT in the population of acute chest pain patients and assessed the relationship of FFR CT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71{\%} men) from the ROMICAT II trial who had ≥50{\%} stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFR CT was measured in a core laboratory. Results: We found correlation between anatomic severity of stenosis and FFR CT ≤0.80 vs. FFR CT >0.80 (severe stenosis 84.8{\%} vs. 15.2{\%}; moderate stenosis 33.3{\%} vs. 66.7{\%}; mild stenosis 33.3{\%} vs. 66.7{\%} patients). Patients with severe stenosis had lower FFR CT values (median 0.64, 25th-75th percentile 0.50–0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78–0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFR CT ≤0.80 was 4.03 (95{\%} CI 1.56–10.36) and 3.50 (95{\%} CI 1.12–10.96), respectively. FFR CT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95{\%} CI 1.55–9.85, p = 0.004) after adjustment for stenosis severity. Conclusion: Abnormal FFR CT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFR CT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.",
    keywords = "Acute coronary syndrome, Coronary computed tomography angiography, Non-invasive cardiac testing, Non-invasive fractional flow reserve, Risk stratification, Stress test",
    author = "Maros Ferencik and Lu, {Michael T.} and Thomas Mayrhofer and Puchner, {Stefan B.} and Ting Liu and Pal Maurovich-Horvat and Khristine Ghemigian and Alexander Ivanov and Elizabeth Adami and Nagurney, {John T.} and Woodard, {Pamela K.} and Truong, {Quynh A.} and Udelson, {James E.} and Udo Hoffmann",
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    }

    TY - JOUR

    T1 - Non-invasive fractional flow reserve derived from coronary computed tomography angiography in patients with acute chest pain

    T2 - Subgroup analysis of the ROMICAT II trial

    AU - Ferencik, Maros

    AU - Lu, Michael T.

    AU - Mayrhofer, Thomas

    AU - Puchner, Stefan B.

    AU - Liu, Ting

    AU - Maurovich-Horvat, Pal

    AU - Ghemigian, Khristine

    AU - Ivanov, Alexander

    AU - Adami, Elizabeth

    AU - Nagurney, John T.

    AU - Woodard, Pamela K.

    AU - Truong, Quynh A.

    AU - Udelson, James E.

    AU - Hoffmann, Udo

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - Background: Non-invasive fractional flow reserve (FFR CT ) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFR CT in the population of acute chest pain patients and assessed the relationship of FFR CT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFR CT was measured in a core laboratory. Results: We found correlation between anatomic severity of stenosis and FFR CT ≤0.80 vs. FFR CT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFR CT values (median 0.64, 25th-75th percentile 0.50–0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78–0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFR CT ≤0.80 was 4.03 (95% CI 1.56–10.36) and 3.50 (95% CI 1.12–10.96), respectively. FFR CT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55–9.85, p = 0.004) after adjustment for stenosis severity. Conclusion: Abnormal FFR CT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFR CT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.

    AB - Background: Non-invasive fractional flow reserve (FFR CT ) derived from coronary computed tomography angiography (CTA) permits hemodynamic evaluation of coronary stenosis and may improve efficiency of assessment in stable chest pain patients. We determined feasibility of FFR CT in the population of acute chest pain patients and assessed the relationship of FFR CT with outcomes of acute coronary syndrome (ACS) and revascularization and with plaque characteristics. Methods: We included 68 patients (mean age 55.8 ± 8.4 years, 71% men) from the ROMICAT II trial who had ≥50% stenosis on coronary CTA or underwent additional non-invasive stress test. We evaluated coronary stenosis and high-risk plaque on coronary CTA. FFR CT was measured in a core laboratory. Results: We found correlation between anatomic severity of stenosis and FFR CT ≤0.80 vs. FFR CT >0.80 (severe stenosis 84.8% vs. 15.2%; moderate stenosis 33.3% vs. 66.7%; mild stenosis 33.3% vs. 66.7% patients). Patients with severe stenosis had lower FFR CT values (median 0.64, 25th-75th percentile 0.50–0.75) as compared to patients with moderate (median 0.84, 25th-75th percentile, p < 0.001) or mild stenosis (median 0.86, 25th-75th percentile 0.78–0.88, p < 0.001). The relative risk of ACS and revascularization in patients with positive FFR CT ≤0.80 was 4.03 (95% CI 1.56–10.36) and 3.50 (95% CI 1.12–10.96), respectively. FFR CT ≤0.80 was associated with the presence of high-risk plaque (odds ratio 3.91, 95% CI 1.55–9.85, p = 0.004) after adjustment for stenosis severity. Conclusion: Abnormal FFR CT was associated with the presence of ACS, coronary revascularization, and high-risk plaque. FFR CT measurements correlated with anatomic severity of stenosis on coronary CTA and were feasible in population of patients with acute chest pain.

    KW - Acute coronary syndrome

    KW - Coronary computed tomography angiography

    KW - Non-invasive cardiac testing

    KW - Non-invasive fractional flow reserve

    KW - Risk stratification

    KW - Stress test

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    U2 - 10.1016/j.jcct.2019.05.009

    DO - 10.1016/j.jcct.2019.05.009

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    JF - Journal of Cardiovascular Computed Tomography

    SN - 1934-5925

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