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Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis.

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Title: Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis.
Authors: Plank, Fabian, Burghard, Philipp1, Friedrich, Guy2, Dichtl, Wolfgang2, Mayr, Agnes1, Klauser, Andrea1, Wolf, Florian3, Feuchtner, Gudrun1 gudrun.feuchtner@gmail.com
Source: European Radiology. Nov2016, Vol. 26 Issue 11, p3781-3789. 9p.
Subjects: Coronary artery stenosis, Revascularization (Surgery), Cerebral revascularization, Coronary angiography, Angiography
Abstract: Objective: To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization.Methods: 160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (>70 % stenosis, FFR <0.8).Results: 210 coronary segments were included (59 % positive). MLA of ≤1.8 mm2 was identified as the optimal cut-off (c = 0.97, p < 0.001; 95 % CI 0.94-0.99) (sensitivity 90.9 %, specificity 89.3 %) for prediction of functional-relevant stenosis (for MLA >2.1 mm2 sensitivity was 100 %). The optimal cut-off for MLD was 1.2 mm (c = 0.92; p < 0.001; 95 % CI 0.88-95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95 % CI 0.84-93, c = 0.87; 95 % CI 0.82-92, respectively, with thresholds at 73 % and 61 % stenosis). Accuracy for LL was c = 0.74 (95 % CI 0.67-81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84.Conclusions: MLA ≤1.8 mm2 and MLD ≤1.2 mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis.Key Points: • Quantitative coronary CT-angiography is accurate for prediction of functional relevant stenosis. • Absolute lumen area and diameter rather than %stenosis predict functional relevance. • Lumen area <1.8 mm 2 and diameter <1.2 mm are the most accurate cut-offs. • Quantitative parameters are helpful for decision-making in terms of patient management. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Quantitative coronary CT angiography: absolute lumen sizing rather than %stenosis predicts hemodynamically relevant stenosis.
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Plank%2C+Fabian%22&quot;&gt;Plank, Fabian&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Burghard%2C+Philipp%22&quot;&gt;Burghard, Philipp&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Friedrich%2C+Guy%22&quot;&gt;Friedrich, Guy&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Dichtl%2C+Wolfgang%22&quot;&gt;Dichtl, Wolfgang&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Mayr%2C+Agnes%22&quot;&gt;Mayr, Agnes&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Klauser%2C+Andrea%22&quot;&gt;Klauser, Andrea&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Wolf%2C+Florian%22&quot;&gt;Wolf, Florian&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Feuchtner%2C+Gudrun%22&quot;&gt;Feuchtner, Gudrun&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;i&gt; gudrun.feuchtner@gmail.com&lt;/i&gt;
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  Data: &lt;searchLink fieldCode=&quot;JN&quot; term=&quot;%22European+Radiology%22&quot;&gt;European Radiology&lt;/searchLink&gt;. Nov2016, Vol. 26 Issue 11, p3781-3789. 9p.
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Coronary+artery+stenosis%22&quot;&gt;Coronary artery stenosis&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Revascularization+%28Surgery%29%22&quot;&gt;Revascularization (Surgery)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Cerebral+revascularization%22&quot;&gt;Cerebral revascularization&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Coronary+angiography%22&quot;&gt;Coronary angiography&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22Angiography%22&quot;&gt;Angiography&lt;/searchLink&gt;
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  Data: &lt;bold&gt;Objective: &lt;/bold&gt;To identify the most accurate quantitative coronary stenosis parameter by CTA for prediction of functional significant coronary stenosis resulting in coronary revascularization.&lt;bold&gt;Methods: &lt;/bold&gt;160 consecutive patients were prospectively examined with CTA. Proximal coronary stenosis was quantified by minimal lumen area (MLA) and minimal lumen diameter (MLD), %area and %diameter stenosis. Lesion length (LL) was measured. The reference standard was invasive coronary angiography (ICA) (&gt;70&#160;% stenosis, FFR &lt;0.8).&lt;bold&gt;Results: &lt;/bold&gt;210 coronary segments were included (59&#160;% positive). MLA of ≤1.8&#160;mm2 was identified as the optimal cut-off (c = 0.97, p &lt; 0.001; 95&#160;% CI 0.94-0.99) (sensitivity 90.9&#160;%, specificity 89.3&#160;%) for prediction of functional-relevant stenosis (for MLA &gt;2.1&#160;mm2 sensitivity was 100&#160;%). The optimal cut-off for MLD was 1.2&#160;mm (c = 0.92; p &lt; 0.001; 95&#160;% CI 0.88-95) (sensitivity 90.9, specificity 85.2) while %area and %diameter stenosis were less accurate (c = 0.89; 95&#160;% CI 0.84-93, c = 0.87; 95&#160;% CI 0.82-92, respectively, with thresholds at 73&#160;% and 61&#160;% stenosis). Accuracy for LL was c = 0.74 (95&#160;% CI 0.67-81), and for LL/MLA and LL/MLD ratio c = 0.90 and c = 0.84.&lt;bold&gt;Conclusions: &lt;/bold&gt;MLA ≤1.8&#160;mm2 and MLD ≤1.2&#160;mm are the most accurate cut-offs for prediction of haemodynamically significant stenosis by ICA, with a higher accuracy than relative % stenosis.&lt;bold&gt;Key Points: &lt;/bold&gt;• Quantitative coronary CT-angiography is accurate for prediction of functional relevant stenosis. • Absolute lumen area and diameter rather than %stenosis predict functional relevance. • Lumen area &lt;1.8&#160;mm 2 and diameter &lt;1.2&#160;mm are the most accurate cut-offs. • Quantitative parameters are helpful for decision-making in terms of patient management. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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