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

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Abstract

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.

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Most cited references 36

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Atherosclerotic plaques that lead to acute coronary syndromes often occur at sites of angiographically mild coronary-artery stenosis. Lesion-related risk factors for such events are poorly understood. In a prospective study, 697 patients with acute coronary syndromes underwent three-vessel coronary angiography and gray-scale and radiofrequency intravascular ultrasonographic imaging after percutaneous coronary intervention. Subsequent major adverse cardiovascular events (death from cardiac causes, cardiac arrest, myocardial infarction, or rehospitalization due to unstable or progressive angina) were adjudicated to be related to either originally treated (culprit) lesions or untreated (nonculprit) lesions. The median follow-up period was 3.4 years. The 3-year cumulative rate of major adverse cardiovascular events was 20.4%. Events were adjudicated to be related to culprit lesions in 12.9% of patients and to nonculprit lesions in 11.6%. Most nonculprit lesions responsible for follow-up events were angiographically mild at baseline (mean [±SD] diameter stenosis, 32.3±20.6%). However, on multivariate analysis, nonculprit lesions associated with recurrent events were more likely than those not associated with recurrent events to be characterized by a plaque burden of 70% or greater (hazard ratio, 5.03; 95% confidence interval [CI], 2.51 to 10.11; P<0.001) or a minimal luminal area of 4.0 mm(2) or less (hazard ratio, 3.21; 95% CI, 1.61 to 6.42; P=0.001) or to be classified on the basis of radiofrequency intravascular ultrasonography as thin-cap fibroatheromas (hazard ratio, 3.35; 95% CI, 1.77 to 6.36; P<0.001). In patients who presented with an acute coronary syndrome and underwent percutaneous coronary intervention, major adverse cardiovascular events occurring during follow-up were equally attributable to recurrence at the site of culprit lesions and to nonculprit lesions. Although nonculprit lesions that were responsible for unanticipated events were frequently angiographically mild, most were thin-cap fibroatheromas or were characterized by a large plaque burden, a small luminal area, or some combination of these characteristics, as determined by gray-scale and radiofrequency intravascular ultrasonography. (Funded by Abbott Vascular and Volcano; ClinicalTrials.gov number, NCT00180466.).

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Author and article information

Contributors

Gilwoo Choi: URI : http://loop.frontiersin.org/people/1440827/overview

Eun-Seok Shin: URI : http://loop.frontiersin.org/people/1348811/overview

Eun Ju Chun: URI : http://loop.frontiersin.org/people/1405511/overview

Koen Nieman: URI : http://loop.frontiersin.org/people/1270507/overview

Charles A. Taylor: URI : http://loop.frontiersin.org/people/1440561/overview

Bon-Kwon Koo: URI : http://loop.frontiersin.org/people/1307778/overview

Journal

Journal ID (nlm-ta): Front Cardiovasc Med

Journal ID (iso-abbrev): Front Cardiovasc Med

Journal ID (publisher-id): Front. Cardiovasc. Med.

Title: Frontiers in Cardiovascular Medicine

Publisher: Frontiers Media S.A.

ISSN (Electronic): 2297-055X

Publication date (Electronic): 13 September 2021

Publication date Collection: 2021

Volume: 8

Electronic Location Identifier: 713835

Affiliations

[1] ¹Department of Internal Medicine and Cardiovascular Center, Seoul National University , Seoul, South Korea

[2] ²HeartFlow Inc. , Redwood City, CA, United States

[3] ³Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University , Hangzhou, China

[4] ⁴Department of Internal Medicine and Cardiovascular Center, Samsung Medical Center, Sungkyunkwan University , Seoul, South Korea

[5] ⁵Department of Medicine, Inje University Ilsan Paik Hospital , Goyang, South Korea

[6] ⁶Department of Medicine, Dongsan Medical Center, Keimyung University , Daegu, South Korea

[7] ⁷Department of Cardiology, Ulsan Hospital , Ulsan, South Korea

[8] ⁸Cardiovascular Center, Sejong General Hospital , Incheon, South Korea

[9] ⁹Department of Medicine, Healthcare System Gangnam Center, Seoul National University , Seoul, South Korea

[10] ¹⁰Department of Radiology, Seoul National University Bundang Hospital , Seongnam, South Korea

[11] ¹¹Department of Cardiology, Aarhus University Hospital , Aarhus, Denmark

[12] ¹²School of Medicine, Cardiovascular Institute, Stanford University , Stanford, CA, United States

[13] ¹³Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Graduate School of Medicine, Kobe University , Kobe, Japan

[14] ¹⁴Cardiovascular Center Aalst, OLV-Clinic , Aalst, Belgium

[15] ¹⁵Department of Cardiovascular Medicine, Wakayama Medical University , Wakayama, Japan

[16] ¹⁶Department of Bioengineering, Stanford University , Stanford, CA, United States

[17] ¹⁷Institute on Aging, Seoul National University , Seoul, South Korea

Author notes

Edited by: Christos Bourantas, University College London, United Kingdom

Reviewed by: Ryo Torii, University College London, United Kingdom; Eric Poon, St Vincent's Hospital (Melbourne), Australia

*Correspondence: Bon-Kwon Koo bkkoo@ 123456snu.ac.kr

This article was submitted to Cardiovascular Imaging, a section of the journal Frontiers in Cardiovascular Medicine

Article

DOI: 10.3389/fcvm.2021.713835

PMC ID: 8475759

PubMed ID: 34589527

SO-VID: cf9ab745-b95d-4652-85a5-431b4d0d220c

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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 24 May 2021

Date accepted : 12 August 2021

Page count

Figures: 4, Tables: 4, Equations: 0, References: 36, Pages: 12, Words: 7530

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

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Karger: Cardiovascular System

Most cited references 36

2018 ESC/EACTS Guidelines on myocardial revascularization

A prospective natural-history study of coronary atherosclerosis.

Heart disease and stroke statistics--2013 update: a report from the American Heart Association.

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