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Abstract

BACKGROUND:
Atherosclerotic plaque characteristics may affect downstream myocardial perfusion, as well as coronary lesion severity.

OBJECTIVES:
This study sought to evaluate the association between quantitative plaque burden and plaque morphology obtained using coronary computed tomography angiography (CTA) and quantitative myocardial perfusion obtained using [15O]H2O positron emission tomography (PET), as well as fractional flow reserve (FFR) derived invasively.

METHODS:
Two hundred eight patients (63% men; age 58 ± 8.7 years) with suspected coronary artery disease were prospectively included. All patients underwent 256-slice coronary CTA, [15O]H2O PET, and invasive FFR measurements. Coronary CTA-derived plaque burden and morphology were assessed using commercially available software and compared with PET perfusion and FFR.

RESULTS:
Atherosclerotic plaques were present in 179 patients (86%) and 415 of 610 (68%) evaluable coronary arteries. On a per-vessel basis, traditional coronary plaque burden indexes, such as plaque length and volume, minimal lumen area, and stenosis percentage, were significantly associated with impaired hyperemic myocardial blood flow (MBF) and FFR. In addition, morphological features, such as partially calcified plaques, positive remodeling (PR), and low attenuation plaque, displayed a negative impact on hyperemic MBF and FFR. Multivariable analysis revealed that the morphological feature of PR was independently related to impaired hyperemic MBF as well as an unfavorable FFR (p = 0.004 and p = 0.007, respectively), next to stenosis percentage (p = 0.001 and p < 0.001, respectively) and noncalcified plaque volume (p < 0.001 and p = 0.010, respectively).

CONCLUSIONS:
PR and noncalcified plaque volume are associated with detrimental downstream hyperemic myocardial perfusion and FFR, independent of lesion severity.

Author information

Driessen RS1, Stuijfzand WJ1, Raijmakers PG2, Danad I1, Min JK3, Leipsic JA4, Ahmadi A5, Narula J5, van de Ven PM6, Huisman MC2, Lammertsma AA2, van Rossum AC1, van Royen N1, Knaapen P7.

1 Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands.
2 Department of Radiology, Nuclear Medicine & PET Research, VU University Medical Center, Amsterdam, the Netherlands.
3 Institute for Cardiovascular Imaging, Weill-Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
4 Department of Medicine and Radiology, University of British Columbia, Vancouver, Canada.
5 Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
6 Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands.
7 Department of Cardiology, VU University Medical Center, Amsterdam, the Netherlands. Electronic address: p.knaapen@vumc.nl.