CCTA-derived functional and morphological features and their comparative performance in predicting impaired coronary vasodilatation by PET-myocardial perfusion imaging

European Heart Journal - Cardiovascular Imaging, vol. 22

Abstract

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported in part from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2020 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR) , no. GR 5002802 ,and by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Assessment of coronary atherosclerosis: a new complete, anatomo-functional, morphological and biomechanical approach”, Project no. 504776 onbehalf EVINCI-SMARTOOL Background/Objectives: The relationship between biomechanical characteristics of a coronary lesion with myocardial blood flow has not been studied. We investigated the relationship between local endothelial shear stress (ESS) and computed tomography coronary angiography (CTCA)-derived anatomical and plaque characteristics data with impaired vasodilating capability assessed by positron emission tomography myocardial perfusion imaging (PET-MPI). Methods A total of 92 coronary vessels of 53 patients who have undergone both CTCA and PET-MPI with 15O-water or 13N-ammonia were analysed. PET was considered abnormal when > 1 contiguous segments showed both stress Myocardial Blood Flow (MBF) ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or <1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively. CTCA images were used to assess stenosis severity, lesion specific total plaque volume (PV), non-calcified PV and calcified PV as well as plaque phenotype. ESS was calculated for the full length of a lesion (total), as well as in the proximal, minimum lumen area and distal lesion segments. Results ESS was weakly correlated with total PV (rho = 0.273, p = 0.008), non-calcified PV (rho = 0.247, p = 0.017) and the volume of necrotic core (rho = 0.242, p = 0.02). ESS increased progressively with stenosis severity (p ≤ 0.001). ΕSS was also higher in functionally significant vs. non-significant lesions (10.4 [8.04-54.4] Pa vs. 3.9 [2.32-7.29] Pa, p ≤0.001). Addition of ESS to stenosis severity improved prediction (Δ[AUC]:0.113, 95% CI: 0.055 to 0.171, p = 0.0001) of functionally significant lesions. Conclusion There is a weak positive association between lesion-specific ESS and plaque volume. ESS increases progressively with stenosis severity and is higher in functionally significant lesions by PET-MPI. The addition of ESS to CTCA-anatomical information improves prediction of an abnormal PET-MPI result.

Authors 15

1. Georgios-Eleftherios Kalykakis

   Academy of Athens · Biomedical Research Foundation of the Academy of Athens

   Affiliation as printed

   Academy of Athens Biomedical Research Foundation, Athens, Greece

2. Athanassios Antonopoulos

   Royal Brompton Hospital

   Affiliation as printed

   Royal Brompton Hospital, CMR Unit, London, United Kingdom of Great Britain & Northern Ireland

3. T Pitsariotis

   University of Patras

   Affiliation as printed

   University of Patras, Department of Mechanical Engineering and Aeronautics, Patras, Greece

4. Panagiotis K. Siogkas

   University of Ioannina

   Affiliation as printed

   University of Ioannina, Ioannina, Greece

5. Themis Exarchos

   Ionian University

   Affiliation as printed

   Ionian University, Department of Informatics, Kerkyra, Greece

6. Pavlos P. Kafouris

   National and Kapodistrian University of Athens

   Affiliation as printed

   National & Kapodistrian University of Athens, Department of informatics and telecommunications, Athens, Greece

7. Riccardo Liga

   University of Pisa

   Affiliation as printed

   University of Pisa, Cardiothoracic and Vascular , Pisa, Italy

8. Andreas A. Giannopoulos

   University Hospital Zurich

   Affiliation as printed

   University Hospital Zurich, Zurich, Switzerland

9. A Scolte Aachen Department Of Cardiology, Leiden

   Leiden University Medical Center

   Affiliation as printed

   Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands (The)

10. Philipp Antonio Kaufmann

    University of Zurich

    Affiliation as printed

    University of Zurich, Cardiac Imaging, Nuclear Medicine Department, Zurich, Switzerland

11. Oberdan Parodi

    Neuroscience Institute

    Affiliation as printed

    Institute of Neuroscience of CNR, Pisa, Italy

12. Juhani M. Knuuti

    Turku University Hospital

    Affiliation as printed

    Turku University Hospital, Turku, Finland

13. Dimitrios I. Fotiadis

    University of Ioannina

    Affiliation as printed

    University of Ioannina, Ioannina, Greece

14. Danilo Neglia

    Neuroscience Institute

    Affiliation as printed

    Institute of Neuroscience of CNR, Pisa, Italy

15. Constantinos Anagnostopoulos

    Academy of Athens · Biomedical Research Foundation of the Academy of Athens

    Affiliation as printed

    Academy of Athens Biomedical Research Foundation, Athens, Greece