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      Functional assessment of coronary plaques using CT based hemodynamic simulations: Current status, technical principles and clinical value

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          Abstract

          In recent years, coronary computed tomography angiography (CCTA) has emerged as an accurate and safe non-invasive imaging modality in terms of detecting and excluding coronary artery disease (CAD). In the latest European Society of Cardiology Guidelines CCTA received Class I recommendation for the evaluation of patients with stable chest pain with low to intermediate clinical likelihood of CAD. Despite its high negative predictive value, the diagnostic performance of CCTA is limited by the relatively low specificity, especially in patients with heavily calcified lesions. The discrepancy between the degree of stenosis and ischemia is well established based on both invasive and non-invasive tests. The rapid evolution of computational flow dynamics has allowed the simulation of CCTA derived fractional flow reserve (FFR-CT), which improves specificity by combining anatomic and functional information regarding coronary atherosclerosis. FFR-CT has been extensively validated against invasively measured FFR as the reference standard. Due to recent technological advancements FFR-CT values can also be calculated locally, without offsite processing. Wall shear stress (WSS) and axial plaque stress (APS) are additional key hemodynamic elements of atherosclerotic plaque characteristics, which can also be measured using CCTA images. Current evidence suggests that WSS and APS are important hemodynamic features of adverse coronary plaques. CCTA based hemodynamic calculations could therefore improve prognostication and the management of patients with stable CAD.

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          Author and article information

          Contributors
          Journal
          1647
          Imaging
          Imaging
          Akadémiai Kiadó (Budapest )
          2732-0960
          19 June 2021
          10 March 2021
          : 13
          : 1
          : 37-48
          Affiliations
          [1 ] MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University , Budapest, Hungary
          [2 ] Department of Radiology, Medical Imaging Centre, Semmelweis University , Budapest, Hungary
          Author notes
          [* ]Corresponding author. Tel.: +36 20 666 3857. E-mail: melinda.b.md@ 123456gmail.com
          Article
          10.1556/1647.2020.00011
          e0e0114c-f51c-4f98-bb87-5cdc9002503f
          © 2020 The Author(s)

          Open Access. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated. (SID_1)

          Page count
          Figures: 3, Tables: 2, Equations: 0, References: 65, Pages: 12
          Funding
          Funded by: National Research, Development and Innovation Office of the Ministry of Innovation and Technology
          Funded by: Ministry of Human Capacities in Hungary
          Funded by: Bálint Szilveszter
          Award ID: ÚNKP 2020/21
          Funded by: Thematic Excellence Programme
          Award ID: 2020-4.1.1.-TKP2020
          Custom metadata
          1

          Medicine,Immunology,Health & Social care,Microbiology & Virology,Infectious disease & Microbiology
          computed tomography angiography derived fractional flow reserve,axial plaque stress,computational fluid dynamic,coronary artery disease,wall shear stress

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