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Lesion-specific and vessel-related determinants of FFR.

Session Poster session 1

Speaker Jonathon Leipsic

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : A Ahmadi (New York,US), J Leipsic (Vancouver,CA), K Ovrehus (Aarhus,DK), S Gaur (Aarhus,DK), J Jensen (Aarhus,DK), G Larocca (New York,US), E Bagiella (New York,US), H Botker (Aarhus,DK), D Dey (Los Angeles,US), B Norgaard (Aarhus,DK), J Narula (New York,US)

A. Ahmadi1 , J. Leipsic2 , K. Ovrehus3 , S. Gaur3 , J. Jensen3 , G. Larocca1 , E. Bagiella1 , H. Botker3 , D. Dey4 , B. Norgaard3 , J. Narula1 , 1Mount Sinai School of Medicine, Cardiology - New York - United States of America , 2University of British Columbia, Cardiology - Vancouver - Canada , 3Aarhus University Hospital, Cardiology - Aarhus - Denmark , 4Cedars-Sinai Medical Center - Los Angeles - United States of America ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 194

Background: The stenosis – ischemia relationship is far from perfect. Numerous reports have described cases of stenosis without ischemia or ischemia without stenosis. The aim of this study is to investigate the value of various lesion-specific and vessel-related factors in predicting invasive FFR.

Methods: In a prospective, multicenter study of 254 patients (64±10 years, 64% male), coronary CT angiography (CCTA), invasive angiography (ICA) and FFR were evaluated for 383 lesions. Ischemia was defined by invasive FFR ≤0.80. CTA defined lesion specific factors included non-calcified plaque volume, calcified plaque volume, low attenuation plaque (LAP) volume, % stenosis, lesion length, and remodelling index. CTA defined vessel -related factors included vessel territory (LAD, RCA, LCx), lesion location within the vessel (proximal, middle, distal) and number of lesions in the vessels. Univariate and multivariate analyses were performed to examine the predictive value of various lesion- and vessel-related factors for invasive FFR.

Results: Amongst lesion specific factors, % stenosis (R2 = -0.38, P<0.0001) and LAP volume (R2 =-0.22, P<0.0001) were independent predictors of invasive FFR in both univariate and multivariate models. Amongst vessel factors, LAD territory (R2 = -0.35, P<0.0001) and presence of multiple lesion per vessel (R2 = -0.30, P<0.0001) were independent predictors of invasive FFR. In a sub-analysis of vessels with only one lesion in the vessel, % stenosis (R2 = -0.31, P<0.0001) and LAP volume (R2 = -0.45, P<0.0001), along with LAD territory (R2 = -0.39, P<0.0001) were the only significant independent predictors of FFR. Amongst lesions categorized based on degree of stenosis (<50%, 50–70%, >70%), FFR negative lesions had consistently smaller LAP volume compared to FFR positive lesions, independent of degree of stenosis.

Conclusion: Amongst all lesion-specific and vessel-related factors, % stenosis, LAP volume, LAD territory and number of lesions per vessel are independent predictors of FFR. In lesions with similar degree of stenosis, FFR negative lesions have significantly lower LAP volume compared to FFR positive lesions. The relationship between LAP volume and FFR, especially in lesions with similar degree of luminal stenosis might be a key factor in understanding the clinical outcomes associated with FFR-guided therapy.

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