Association Among Local Hemodynamic Parameters Derived From CT Angiography and Their Comparable Implications in Development of Acute Coronary Syndrome,Frontiers in Cardiovascular Medicine

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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

Department of Internal Medicine and Cardiovascular Center, Seoul National University, Seoul, South Korea.
HeartFlow Inc., Redwood City, CA, United States.
Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea.
Department of Medicine, Dongsan Medical Center, Keimyung University, Daegu, South Korea.
Department of Cardiology, Ulsan Hospital, Ulsan, South Korea.
Cardiovascular Center, Sejong General Hospital, Incheon, South Korea.
Department of Medicine, Healthcare System Gangnam Center, Seoul National University, Seoul, South Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
School of Medicine, Cardiovascular Institute, Stanford University, Stanford, CA, United States.
Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Department of Bioengineering, Stanford University, Stanford, CA, United States.
Institute on Aging, Seoul National University, Seoul, South Korea.

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 (FFR_CT) and local hemodynamic parameters including wall shear stress (WSS), axial plaque stress (APS), pressure gradient (PG) across the lesion, and delta FFR_CT across the lesion (ΔFFR_CT) 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 ΔFFR_CT 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 FFR_CT ≤ 0.80. In discrimination of culprit lesions causing ACS from non-culprit lesions, WSS, PG, APS, and ΔFFR_CT were independent predictors after adjustment for lesion characteristics, high-risk plaque, and FFR_CT ≤ 0.80; and all local hemodynamic parameters significantly improved the predictive value for culprit lesions of high-risk plaque and FFR_CT ≤ 0.80 (all p < 0.05). The risk prediction model for culprit lesions with FFR_CT ≤ 0.80, high-risk plaque, and ΔFFR_CT had a similar or superior discrimination ability to that with FFR_CT ≤ 0.80, high-risk plaque, and WSS, APS, or PG; and the addition of WSS, APS, or PG into ΔFFR_CT 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 FFR_CT.

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_的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。