Computed tomography coronary angiography assessment of left main coronary artery stenosis severity

IF 5.5 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Computed Tomography Pub Date : 2024-11-01 DOI:10.1016/j.jcct.2024.07.005

Udit Thakur , Jason Nogic , Andrea Comella , Nitesh Nerlekar , Jasmine Chan , Timothy Abrahams , Michael Michail , Adam Nelson , Damini Dey , Brian Ko , Sujith Seneviratne , Adam J. Brown

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引用次数: 0

Abstract

Background

Angiographic assessment of left main coronary artery (LMCA) stenosis severity can be unreliable. In cases of ambiguity, intravascular ultrasound (IVUS) can be utilised with a minimal lumen area (MLA) of ≥6 mm² an accepted threshold for safe deferral of revascularization. We sought to assess whether quantitative computer tomography coronary angiography (CTCA) measures could assist clinicians making LMCA revascularization decisions when compared with IVUS as gold standard.

Methods

Consecutive patients undergoing IVUS assessment of angiographically intermediate LMCA stenosis were included. All patients had undergone 320-slice CTCA <90 days prior to IVUS imaging. Offline quantitative assessment of IVUS- and CT-derived measures were undertaken with the cohort divided into those with significant (s-LMCA) versus non-significant (ns-LMCA) disease using the accepted IVUS threshold.

Results

Fifty-eight patients were included, with no difference in mean age (61.5 ± 12.2 vs. 59.7 ± 11.9 years, p = 0.57), diabetic status (24.2% vs 16.0%, p = 0.44) or other baseline demographics between groups. Patients with ns-LMCA had larger CT luminal area (8.64 ± 3.91 vs. 5.41 ± 1.54 mm², p < 0.001), larger minimal lumen diameter (MLD) (3.25 ± 0.74 vs. 2.56 ± 0.38 mm, p < 0.001) and lower area stenosis (45.74 ± 18.10 vs. 60.93 ± 14.68%, p = 0.001). There was a significant positive correlation between CTCA and IVUS MLA (r = 0.68, p < 0.001) and MLD (r = 0.67, p < 0.001). ROC analysis demonstrated CTCA MLA cut-off <8.29 mm² provides the greatest negative predictive value and sensitivity in predicting the presence of significant LMCA disease.

Conclusion

CTCA derived MLA and MLD have a strong correlation with IVUS. A CTCA derived MLA cut-off <8.29 mm² showed greatest clinical utility for predicting the need for further assessment, based on IVUS gold standard.

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计算机断层扫描冠状动脉造影术对左冠状动脉主干狭窄严重程度的评估。

背景：左冠状动脉主干（LMCA）狭窄严重程度的血管造影评估可能并不可靠。在不明确的情况下，可以使用血管内超声（IVUS），最小管腔面积（MLA）≥6 平方毫米是安全推迟血管再通的公认阈值。我们试图评估定量计算机断层扫描冠状动脉造影（CTCA）与作为金标准的 IVUS 相比，是否能帮助临床医生做出 LMCA 血管再通的决定：纳入接受 IVUS 评估的 LMCA 中度血管狭窄连续患者。所有患者均接受过 320 片 CTCA 结果：共纳入 58 例患者：纳入的 58 例患者的平均年龄（61.5 ± 12.2 岁 vs. 59.7 ± 11.9 岁，P = 0.57）、糖尿病状态（24.2% vs. 16.0%，P = 0.44）或其他基线人口统计学指标在组间无差异。NS-LMCA患者的CT管腔面积更大（8.64 ± 3.91 vs. 5.41 ± 1.54 mm2，p 2），在预测LMCA是否存在重大疾病方面具有最大的阴性预测价值和灵敏度：结论：CTCA 导出的 MLA 和 MLD 与 IVUS 有很强的相关性。结论：CTCA 导出的 MLA 和 MLD 与 IVUS 有很强的相关性。根据 IVUS 黄金标准，CTCA 导出的 MLA 临界值 2 在预测是否需要进一步评估方面显示出最大的临床实用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Computed Tomography CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

7.50

自引率

14.80%

发文量

212

审稿时长

40 days

期刊介绍： The Journal of Cardiovascular Computed Tomography is a unique peer-review journal that integrates the entire international cardiovascular CT community including cardiologist and radiologists, from basic to clinical academic researchers, to private practitioners, engineers, allied professionals, industry, and trainees, all of whom are vital and interdependent members of our cardiovascular imaging community across the world. The goal of the journal is to advance the field of cardiovascular CT as the leading cardiovascular CT journal, attracting seminal work in the field with rapid and timely dissemination in electronic and print media.