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Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome
Frontiers in Cardiovascular Medicine ( IF 2.8 ) Pub Date : 2021-09-13 , DOI: 10.3389/fcvm.2021.713835
Seokhun Yang 1 , Gilwoo Choi 2 , Jinlong Zhang 3 , Joo Myung Lee 4 , Doyeon Hwang 1 , Joon-Hyung Doh 5 , Chang-Wook Nam 6 , Eun-Seok Shin 7 , Young-Seok Cho 8 , Su-Yeon Choi 9 , Eun Ju Chun 10 , Bjarne L Nørgaard 11 , Koen Nieman 12 , Hiromasa Otake 13 , Martin Penicka 14 , Bernard De Bruyne 14 , Takashi Kubo 15 , Takashi Akasaka 15 , Charles A Taylor 2, 16 , Bon-Kwon Koo 1, 17
Affiliation  

Background: Association among local hemodynamic parameters and their implications in development of acute coronary syndrome (ACS) have not been fully investigated.

Methods: A total of 216 lesions in ACS patients undergoing coronary CT angiography (CCTA) before 1–24 months from ACS event were analyzed. High-risk plaque on CCTA was defined as a plaque with ≥2 of low-attenuation plaque, positive remodeling, spotty calcification, and napkin-ring sign. With the use of computational fluid dynamics analysis, fractional flow reserve (FFR) derived from CCTA (FFRCT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFRCT across the lesion (ΔFFRCT) were obtained. The association among local hemodynamics and their discrimination ability for culprit lesions from non-culprit lesions were compared.

Results: A total of 66 culprit lesions for later ACS and 150 non-culprit lesions were identified. WSS, APS, PG, and ΔFFRCT were strongly correlated with each other (all p < 0.001). This association was persistent in all lesion subtypes according to a vessel, lesion location, anatomical severity, high-risk plaque, or FFRCT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFRCT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFRCT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFRCT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFRCT ≤ 0.80, high-risk plaque, and ΔFFRCT had a similar or superior discrimination ability to that with FFRCT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFRCT did not improve the model performance.

Conclusions: Local hemodynamic indices were significantly intercorrelated, and all indices similarly provided additive and independent predictive values for ACS risk over high-risk plaque and impaired FFRCT.



中文翻译:

CT血管造影得出的局部血流动力学参数之间的关联及其在急性冠状动脉综合征发展中的可比意义

背景: 局部血流动力学参数之间的关联及其在急性冠状动脉综合征 (ACS) 发展中的影响尚未得到充分研究。

方法:对 ACS 事件发生后 1-24 个月前接受冠状动脉 CT 血管造影 (CCTA) 的 ACS 患者的 216 个病灶进行了分析。CCTA 上的高危斑块被定义为具有≥2 个低衰减斑块、正重塑、点状钙化和餐巾环征的斑块。通过使用计算流体动力学分析,来自 CCTA (FFR CT ) 的流量储备分数 (FFR) 和局部血流动力学参数,包括壁剪切应力 (WSS)、轴向斑块应力 (APS)、穿过病灶的压力梯度 (PG),和跨病灶的delta FFR CT (ΔFFR CT )。比较了局部血流动力学及其区分罪犯病变和非罪犯病变的能力之间的关联。

结果:共确定了 66 个晚期 ACS 的罪魁祸首病变和 150 个非罪魁祸首病变。WSS、APS、PG 和 ΔFFR CT彼此强相关(均p< 0.001)。根据血管、病变位置、解剖严重程度、高危斑块或 FFR CT ≤ 0.80,这种关联在所有病变亚型中都持续存在。在区分导致 ACS 的罪魁祸首和非罪魁祸首病变时,WSS、PG、APS 和 ΔFFR CT是调整病变特征、高危斑块和 FFR CT ≤ 0.80 后的独立预测因子;并且所有局部血流动力学参数均显着提高了对高危斑块和 FFR CT ≤ 0.80 的罪犯病变的预测值(所有p< 0.05)。FFR CT≤0.80、高危斑块、ΔFFR CT罪犯病变风险预测模型与FFR CT≤0.80、高危斑块、WSS、APS或PG的判别能力相似或优于;并且在 ΔFFR CT中添加 WSS、APS 或 PG并没有提高模型性能。

结论:局部血流动力学指标显着相关,所有指标同样为高危斑块和 FFR CT受损的 ACS 风险提供了附加和独立的预测值。

更新日期:2021-09-13
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